Intestinal Transplantation in Children with Intestinal Failure

Published on 27/03/2015 by admin

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Last modified 27/03/2015

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Chapter 331 Intestinal Transplantation in Children with Intestinal Failure

The introduction of tacrolimus and the development of the abdominal multiorgan procurement techniques allowed the tailoring of various types of intestine grafts, which can contain other intra-abdominal organs such as the liver, pancreas, and stomach; this tailoring has been critical to the application of this type of organ transplant, given the wide scope of diseases for which replacement of the intestine may be necessary. Also, the understanding that the liver protects the intestine against rejection had been suggested by previous combinations of liver plus other organs such as the kidney. The first survivors of intestine transplantation would also go on to demonstrate the interaction (host-versus-graft and graft-versus-host) between recipient and donor immunocytes (brought with the allograft), which under the cover of immunosuppression allows varying degrees of graft acceptance and eventual minimization of drug therapy.

Indications for Intestinal Transplant

Intestinal failure (IF) describes a patient who has lost the ability to maintain nutritional support with his or her intestine and is permanently dependent on total parenteral nutrition (TPN). The majority of these patients have short bowels as a result of a congenital deficiency or acquired condition (Chapter 330.7). In others, the cause of IF is a functional disorder of motility or absorption (Table 331-1). Rarely do patients receive intestinal transplants for benign neoplasms. IF is a syndrome that includes “satellite” complications such as loss of venous access, life-threatening infections, and TPN-induced cholestatic liver disease. Patients who develop these complications have a ∼70% 1 yr mortality and thus require organ replacement therapy with intestinal transplantation.