Long-term outcome, growth and digestive function in children 2 to 18 years after intestinal transplantation

Lacaille, F.; Vass, N.; Sauvat, F.; Canioni, D.; Colomb, V.; Talbotec, C.; Patey-Mariaud De Serre, N.; Salomon, J.; Hugot, J.-P.; Cézard, J.-P.; Révillon, Y.; Ruemmele, F. M.; Goulet, O.
April 2008
Gut;Apr2008, Vol. 57 Issue 4, p455
Academic Journal
Objective: Small bowel (SB) transplantation (Tx), long considered a rescue therapy for patients with intestinal failure, is now a well recognised alternative treatment strategy to parental nutrition (PN). In this retrospective study, we analysed graft functions in 31 children after SBTx with a follow-up of 2-18 years (median 7 years). Patients: Twelve children had isolated SBTx, 19 had combined liver-SBTx and 17 received an additional colon graft. Growth, nutritional markers, stool balance studies, endoscopy and graft histology were recorded every 2-3 years post-Tx. Results: All children were weaned from PN after Tx and 26 children remained PN-free. Enteral nutrition was required for 14/31 (45%) patients at 2 years post-Tx. All children had high dietary energy intakes. The degree of steatorrhoea was fairly constant, with fat and energy absorption rates of 84-89%. Growth parameters revealed at transplantation a mean height Z-score of -1.17. After Tx, two-thirds of children had normal growth, whereas in one-third, Z-scores remained lower than -2, concomitant to a delayed puberty. Adult height was normal in 5/6. Endoscopy and histology analyses were normal in asymptomatic patients. Chronic rejection occurred only in non-compliant patients. Five intestinal grafts were removed 2.5-8 years post-Tx for acute or chronic rejection. Conclusions: This series indicates that long-term intestinal autonomy for up to 18 years is possible in the majority of patients after SBTx. Subnormal energy absorption and moderate steatorrhoea were often compensated for by hyperphagia, allowing normal growth and attainment of adult height. Long-term compliance is an important pre-requisite for long-term graft function.


Related Articles

  • Intestino corto: de la resección al trasplante. Rodríguez-Montes, José Antonio // Nutricion Hospitalaria;nov2014, Vol. 30 Issue 5, p961 

    Short bowel syndrome (SBS) is characterized by a significant reduction in the effective intestinal surface by an anatomical or functional loss of the small intestine. It mainly occurs after extensive bowel resection, intestinal intrinsic disease or surgical bypass. The main complications are...

  • Indicaciones, técnicas y resultados del trasplante de intestino delgado. Santamaría, M. López; Oliveros, F. Hernández // Nutricion Hospitalaria;may/jun2007 suppleme, Vol. 22, p113 

    The most recent outcomes on bowel transplantation (BT), with a survival rate immediately after transplant higher than 80% and a great rate of survivors achieving complete digestive autonomy and able to carry out activities according to their age allow for considering BT as the first choice...

  • Chronic idiopathic intestinal pseudo-obstruction treated by near total small bowel resection: a 20-year experience. Lapointe, Roch // Journal of Gastrointestinal Surgery;Dec2010, Vol. 14 Issue 12, p1937 

    Background: Patients suffering from chronic idiopathic intestinal pseudo-obstruction (CIIPO) clearly benefit from home parenteral nutrition (HPN) to maintain adequate nutritional status and general health. But intestinal dismotility can seriously disturb their quality of life (QOL)...

  • Crypt Apoptotic Count Reproducibility in Small Bowel Allograft Biopsies. Talmon, Geoffrey; El Behery, Radwa; Radio, Stanley; Fischer, Ryan; Shostrom, Valerie; Wisecarver, James // International Journal of Surgical Pathology;Jun2013, Vol. 21 Issue 3, p257 

    Enumeration of crypt apoptotic bodies (AB) is used in the diagnosis of acute cellular rejection (ACR) in small bowel allografts. Due to differing definitions, there is a potential for variation in AB numbers between pathologists that may affect diagnosis. Thirty biopsies from allografts were...

  • Short Bowel Syndrome: Parenteral Nutrition Versus Intestinal Transplantation. Where Are We Today? Mark DeLegge; Mohammad Alsolaiman; English Barbour; Samah Bassas; M. Siddiqi; Nicole Moore // Digestive Diseases & Sciences;Apr2007, Vol. 52 Issue 4, p876 

    Abstract  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,...

  • Candidacy for Intestinal Transplantation. O'Keefe, Stephen J. D. // American Journal of Gastroenterology;Jul2006, Vol. 101 Issue 7, p1644 

    A recent report from the American Small Bowel Transplant Registry (2003) has highlighted the significant progressive increase in graft and host survival to over 80% at 1 yr, suggesting that a new era has dawned, and that soon transplantation may offer an attractive alternative to any patient...

  • Prolonged post-reperfusion syndrome during multivisceral organ transplantation in a pediatric patient. Yong-Seok Park; Jin-Young Oh; Bo Young Hwang; Youngjin Moon; Hwa-Mi Lee; Gyu-Sam Hwang // Korean Journal of Anesthesiology;Jun2014, Vol. 66 Issue 6, p467 

    Multivisceral organ transplantation involves the transplantation of three or more abdominal organs, including small bowel, duodenum, stomach, liver, pancreas, colon, and so on. The large amounts of cold and acidic loading into systemic circulation from the graft during multivisceral organ...

  • Cyanoacrylate-assisted arterial anastomosis in rat small bowel transplantation. Wei Wei; Yanfei Zhu; Jian Wang; Yousheng Li; Jieshou Li // Langenbeck's Archives of Surgery;Aug2010, Vol. 395 Issue 6, p727 

    Microarterial anastomosis in rat small bowel transplantation (SBTx) remains technically difficult and time-consuming especially for beginners of microsurgery. In the exploration of the facilitated microarterial anastomosis strategies, we assessed the performance of n-butyl-cyanoacrylate-assisted...

  • Pediatric intestinal transplantation: normal radiographic appearance and complications. Phillips, Grace S.; Bhargava, Puneet; Stanescu, Luana; Dick, André; Parnell, Shawn // Pediatric Radiology;Aug2011, Vol. 41 Issue 8, p1028 

    We present a pictorial essay on pediatric intestinal transplantation that describes the indications for pediatric intestinal transplantation, surgical technique, and the role of imaging in the pre-transplant work-up and detection of post-transplant complications. We illustrate the normal...


Read the Article


Sign out of this library

Other Topics