Small Bowel Transplantation in Children

Reyes, Jorgé; Abu‐Elmagd, Kareem

doi:10.1002/9780470987049.ch21

Cited by 6 publications

(17 citation statements)

References 68 publications

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“…Evaluation of candidates were as previously described. 16 A total of 182 patients have been followed up, which included the 55 transplant recipients and 127 patients who did not undergo transplantation.…”

Section: Case Materialsmentioning

confidence: 99%

Current status of intestinal transplantation in children

Reyes

Bueno

Kocoshis

et al. 1998

Journal of Pediatric Surgery

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221

129

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Purpose-A clinical trial of intestinal transplantation (Itx) under tacrolimus and prednisone immunosuppression was initiated in June 1990 in children with irreversible intestinal failure and who were dependent on total parenteral nutrition (TPN).Methods-Fifty-five patients (28 girls, 27 boys) with a median age of 3.2 years (range, 0.5 to 18 years) received 58 intestinal transplants that included isolated small bowel (SB) (n = 17), liver SB (LSB) (n = 33), and multivisceral (MV) (n = 8) allografts. Nine patients also received bone marrow infusion, and there were 20 colonic allografts. Azathioprine, cyclophosphamide, or mycophenolate mofetil were used in different phases of the series. Indications for Itx included: gastroschisis(n = 14), volvulus (n = 13), necrotizing enterocolitis (n = 6), intestinal atresia (n = 8), chronic intestinal pseudoobstruction (n = 5), Hirschsprung's disease (n = 4), microvillus inclusion disease (n = 3), multiple polyposis (n = 1), and trauma (n = 1).Results-Currently, 30 patients are alive (patient survival, 55%; graft survival, 52%). Twenty-nine children with functioning grafts are living at home and off TPN, with a mean follow-up of 962 (range, 75 to 2,424) days. Immunologic complications have included liver allograft rejection (n = 18), intestinal allograft rejection (n = 52), posttransplant lymphoproliferative disease (n = 16), cytomegalovirus (n = 16) and graft-versus-host disease (n = 4). A combination of associated complications included intestinal perforation (n = 4), biliary leak (n = 3), bile duct stenosis (n = 1), intestinal leak (n = 6), dehiscence with evisceration (n = 4), hepatic artery thrombosis (n = 3), bleeding (n = 9), portal vein stenosis (n = 1), intraabdominal abscess (n = 11), and chylous ascites (n = 4). Graft loss occurred as a result of rejection (n = 8), infection (n = 12), technical complications (n = 8), and complications of TPN after graft removal (n = 3). There were four retransplants (SB, n = 1; LSB n = 3).Conclusions-Intestinal transplantation is a valid therapeutic option for patients with intestinal failure suffering complications of TPN. The complex clinical and immunologic course of these patients is reflected in a higher complication rate as well as patient and graft loss than seen after heart, liver, and kidney transplantation, although better than after lung transplantation.

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Section: Case Materialsmentioning

confidence: 99%

Current status of intestinal transplantation in children

Reyes

Bueno

Kocoshis

et al. 1998

Journal of Pediatric Surgery

Self Cite

221

129

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“…The natural history is that of progressive liver failure and death. Transplantation of intestine/ liver has evolved into a feasible operation with an overall patient and graft survival of 55-73 months [10][11][12][13]. Even if children are candidates for transplantation, death may occur while waiting for a match.…”

Section: Discussionmentioning

confidence: 99%

Gastroschisis Complicated by Midgut Atresia, Absorption of Bowel, and Closure of the Abdominal Wall Defect

Ogunyemi¹

2001

Fetal Diagn Ther

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We present a case of gastroschisis that was associated with progressive resorption of the extra-abdominal bowel loops and dilation of intra-abdominal bowel loops. After preterm delivery at 32 weeks, a small paraumbilical remnant was present. There was complete atresia of most of the jejunum, ileum, cecum, and the proximal half of the transverse colon. At laparotomy, the jejunum was anastomosed to the transverse colon. The neonate developed short gut syndrome and eventually received a liver and intestinal transplant.

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“…Postoperative hemorrhage may be due to coagulopathy or portal hypertension from preexisting liver failure in patients requiring a combined small bowel-liver transplant, from vascularized adhesions due to previous surgeries or technical problems originating from anastomotic leaks, or from bleeding from the peritoneal surfaces. In the setting of normal coagulation, timely surgical re-exploration and repair are necessary [110,[115][116][117][118][119].…”

Section: Surgical Complicationsmentioning

confidence: 99%

“…Surgical re-exploration is required for repair of dehiscence or revision of the anastomosis. Biliary obstruction is a later complication and is usually secondary to the development of a biliary stricture [110,[115][116][117][118][119].…”

Section: Surgical Complicationsmentioning

confidence: 99%

“…Thrombosis of the major arteries results in necrosis of the tissue nourished by that arterial supply which may require graft removal. Venous outflow obstruction may occur in patients receiving an isolated small bowel transplant secondary to obstruction or thrombosis of the anastomosis of the superior mesenteric vein and portal vein axis [110,[115][116][117][118][119].…”

Section: Surgical Complicationsmentioning

confidence: 99%

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Short Bowel Syndrome: Parenteral Nutrition Versus Intestinal Transplantation. Where Are We Today?

et al. 2007

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Current management of short bowel syndrome (SBS) revolves around the use of home TPN (HPN). Complications include liver disease, catheter-related infections or occlusions, venous thrombosis, and bone disease. Patient survival with SBS on TPN is 86% and 75% at 2 and 5 years, respectively. Surgical management of SBS includes nontransplant surgeries such as serial transverse enteroplasty and reanastomosis. Small bowel transplant has become increasingly popular for management of SBS and is usually indicated when TPN cannot be continued. Posttransplant complications include graft-versus-host reaction, infections in an immunocompromised patient, vascular and biliary diseases, and recurrence of the original disease. Following intestinal-only transplants, patient and graft survival rate is 77% and 66% after 1 year. After 5 years the survival figures are 49% and 34%, respectively. Future improvements in survival and quality of life will enhance small bowel transplant as a viable treatment option for patients with SBS.

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Small Bowel Transplantation in Children

Cited by 6 publications

References 68 publications

Current status of intestinal transplantation in children

Current status of intestinal transplantation in children

Gastroschisis Complicated by Midgut Atresia, Absorption of Bowel, and Closure of the Abdominal Wall Defect

Short Bowel Syndrome: Parenteral Nutrition Versus Intestinal Transplantation. Where Are We Today?

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