The role of intestinal transplantation in the management of babies with extensive gut resections

Background/Purpose: Modern neonatal care, surgical treatment, and total parenteral nutrition (TPN) have improved survival rate for babies with extensive gut resections. The authors examined the role of intestinal transplantation in the treatment of these patients. Methods: The authors reviewed all p...

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Published in:Journal of pediatric surgery 2003-02, Vol.38 (2), p.145-149
Main Authors: Kato, Tomoaki, Mittal, Naveen, Nishida, Seigo, Levi, David, Yamashiki, Noriyo, Miller, Barbara, Gonzalez, Monica, Ruiz, Phillip, Madariaga, Juan, Nery, Jose, Gelman, Barry, Thompson, John, Gyamfi, Anthony, Tzakis, Andreas
Format: Article
Language:English
Subjects:
Age Factors
Biological and medical sciences
Body Weight
Child, Preschool
Enterocolitis, Necrotizing - surgery
Female
Follow-Up Studies
Gastroschisis - surgery
Hirschsprung Disease - surgery
Humans
Immunosuppression - methods
Infant
Intestinal Atresia - surgery
Intestinal transplantation
Intestinal Volvulus - surgery
Intestines - abnormalities
Intestines - surgery
Intestines - transplantation
Liver Failure - complications
Liver Failure - surgery
Liver Transplantation - mortality
Male
Medical sciences
Pancreas Transplantation - mortality
Parenteral Nutrition, Total
Reoperation - mortality
Retrospective Studies
short bowel syndrome
Short Bowel Syndrome - complications
Short Bowel Syndrome - mortality
Short Bowel Syndrome - surgery
Stomach - transplantation
Stomach, duodenum, intestine, rectum, anus
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the digestive system
Survival Rate
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Summary:Background/Purpose: Modern neonatal care, surgical treatment, and total parenteral nutrition (TPN) have improved survival rate for babies with extensive gut resections. The authors examined the role of intestinal transplantation in the treatment of these patients. Methods: The authors reviewed all pediatric intestinal transplants performed for short bowel syndrome at our center (70 transplants performed between Aug 1994 and Feb 2002). Factors affecting patient survival were analyzed. Results: Older patient age at the time of transplant was a significant factor favorably affecting patient survival (P =.031). Trends toward better survival rates were observed in those transplants performed more recently (P =.063), in those patients with greater body weight (P =.084), in those not hospitalized at the time of transplant (P =.14), and in those without concomitant liver failure (P =.12). Three-year survival rate for patients greater than age 2 years and without liver failure was 90%. However, 32% of our recipients underwent transplant at age less than one year, and most in this group (75%) had concomitant liver failure. Conclusions: For babies with irreversible intestinal failure, intestinal transplantation is a life-saving option. Results, which have recently improved, are best when transplantation compliments more conservative surgical treatments and TPN. However, there is a subset of patients who have liver disease early requiring urgent transplant. J Pediatr Surg 38:145-149. Copyright 2003, Elsevier Science (USA). All rights reserved.
ISSN:0022-3468
1531-5037
DOI:10.1053/jpsu.2003.50033