Indications for pediatric intestinal transplantation: A position paper of the American Society of Transplantation

Stuart S. Kaufman, James B. Atkinson, Adrian Bianchi, Olivier J. Goulet, David Grant, Alan Norman Langnas, Sue V. McDiarmid, Naveen Mittal, Jorge Reyes, Andreas G. Tzakis

Research output: Contribution to journalReview article

263 Citations (Scopus)

Abstract

Parenteral nutrition represents standard therapy for children with short bowel syndrome and other causes of intestinal failure. Most infants with short bowel syndrome eventually wean from parenteral nutrition, and most of those who do not wean tolerate parenteral nutrition for protracted periods. However, a subset of children with intestinal failure remaining dependent on parenteral nutrition will develop life-threatening complications arising from therapy. Intestinal transplantation (Tx) can now be recommended for this select group. Life-threatening complications warranting consideration of intestinal Tx include parenteral nutrition-associated liver disease, recurrent sepsis, and threatened loss of central venous access. Because a critical shortage of donor organs exists, waiting times for intestinal Tx are prolonged. Therefore, it is essential that children with life-threatening complications of intestinal failure and parenteral nutrition therapy be identified comparatively early, i.e. in time to receive suitable donor organs before they become critically ill. Children with liver dysfunction should be considered for isolated intestinal Tx before irreversible, advanced bridging fibrosis or cirrhosis supervenes, for which a combined liver and intestinal transplant is necessary. Irreversible liver disease is suggested by hyperbilirubinemia persisting beyond 3-4 months of age combined with features of portal hypertension such as splenomegaly, thrombocytopenia, or prominent superficial abdominal veins; esophageal varices, ascites, and impaired synthetic function are not always present. Death resulting from complications of liver failure is especially common during the wait for a combined liver and intestinal transplant, and survival following combined liver and intestinal Tx is probably lower than following an isolated intestinal transplant. The incidence of morbidity and mortality following intestinal Tx is greater than that following liver or kidney Tx, but long-term survival following intestinal Tx is now at least 50-60%. It is probable that outcomes shall improve in the future with continued refinements in operative technique and post-operative management, including immunosuppression.

Original languageEnglish (US)
Pages (from-to)80-87
Number of pages8
JournalPediatric Transplantation
Volume5
Issue number2
DOIs
StatePublished - Apr 25 2001

Fingerprint

Parenteral Nutrition
Transplantation
Pediatrics
Short Bowel Syndrome
Liver Diseases
Liver
Transplants
Fibrosis
Post and Core Technique
Tissue Donors
Nutrition Therapy
Hyperbilirubinemia
Survival
Esophageal and Gastric Varices
Splenomegaly
Liver Failure
Portal Hypertension
Ascites
Critical Illness
Thrombocytopenia

Keywords

  • Child
  • Indications
  • Intestinal transplantation
  • Liver failure
  • Short bowel syndrome

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Transplantation

Cite this

Indications for pediatric intestinal transplantation : A position paper of the American Society of Transplantation. / Kaufman, Stuart S.; Atkinson, James B.; Bianchi, Adrian; Goulet, Olivier J.; Grant, David; Langnas, Alan Norman; McDiarmid, Sue V.; Mittal, Naveen; Reyes, Jorge; Tzakis, Andreas G.

In: Pediatric Transplantation, Vol. 5, No. 2, 25.04.2001, p. 80-87.

Research output: Contribution to journalReview article

Kaufman, SS, Atkinson, JB, Bianchi, A, Goulet, OJ, Grant, D, Langnas, AN, McDiarmid, SV, Mittal, N, Reyes, J & Tzakis, AG 2001, 'Indications for pediatric intestinal transplantation: A position paper of the American Society of Transplantation', Pediatric Transplantation, vol. 5, no. 2, pp. 80-87. https://doi.org/10.1034/j.1399-3046.2001.005002080.x
Kaufman, Stuart S. ; Atkinson, James B. ; Bianchi, Adrian ; Goulet, Olivier J. ; Grant, David ; Langnas, Alan Norman ; McDiarmid, Sue V. ; Mittal, Naveen ; Reyes, Jorge ; Tzakis, Andreas G. / Indications for pediatric intestinal transplantation : A position paper of the American Society of Transplantation. In: Pediatric Transplantation. 2001 ; Vol. 5, No. 2. pp. 80-87.
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abstract = "Parenteral nutrition represents standard therapy for children with short bowel syndrome and other causes of intestinal failure. Most infants with short bowel syndrome eventually wean from parenteral nutrition, and most of those who do not wean tolerate parenteral nutrition for protracted periods. However, a subset of children with intestinal failure remaining dependent on parenteral nutrition will develop life-threatening complications arising from therapy. Intestinal transplantation (Tx) can now be recommended for this select group. Life-threatening complications warranting consideration of intestinal Tx include parenteral nutrition-associated liver disease, recurrent sepsis, and threatened loss of central venous access. Because a critical shortage of donor organs exists, waiting times for intestinal Tx are prolonged. Therefore, it is essential that children with life-threatening complications of intestinal failure and parenteral nutrition therapy be identified comparatively early, i.e. in time to receive suitable donor organs before they become critically ill. Children with liver dysfunction should be considered for isolated intestinal Tx before irreversible, advanced bridging fibrosis or cirrhosis supervenes, for which a combined liver and intestinal transplant is necessary. Irreversible liver disease is suggested by hyperbilirubinemia persisting beyond 3-4 months of age combined with features of portal hypertension such as splenomegaly, thrombocytopenia, or prominent superficial abdominal veins; esophageal varices, ascites, and impaired synthetic function are not always present. Death resulting from complications of liver failure is especially common during the wait for a combined liver and intestinal transplant, and survival following combined liver and intestinal Tx is probably lower than following an isolated intestinal transplant. The incidence of morbidity and mortality following intestinal Tx is greater than that following liver or kidney Tx, but long-term survival following intestinal Tx is now at least 50-60{\%}. It is probable that outcomes shall improve in the future with continued refinements in operative technique and post-operative management, including immunosuppression.",
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AU - Grant, David

AU - Langnas, Alan Norman

AU - McDiarmid, Sue V.

AU - Mittal, Naveen

AU - Reyes, Jorge

AU - Tzakis, Andreas G.

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