Our Summary

This research paper discusses how intestinal and multivisceral transplantation (putting a new intestine or multiple organs into a patient’s body) is a key treatment for kids who suffer from irreversible intestinal failure (a severe problem with their intestines) and complications from parenteral nutrition (when nutrients are given through a vein because the person can’t eat or absorb nutrients from food).

The paper explores how the causes of intestinal failure in children share some similarities with adults, but there are unique factors to consider when evaluating kids for transplantation. Thanks to advancements in managing intestinal failure and in home parenteral nutrition, the criteria for determining which children should receive transplants are continuously updated.

The paper also notes that the outcomes of these transplants have improved over time, with 66.1% of patients and 48.8% of transplanted organs surviving after five years, according to reports from multiple centers.

The paper also discusses specific surgical challenges in children, like closing the abdomen after surgery, outcomes after transplantation, and the quality of life after the procedure.

While intestinal and multivisceral transplantation can save many kids with intestinal failure, maintaining the long-term function of the transplanted organs remains a significant challenge.

FAQs

  1. What is the main purpose of intestinal and multivisceral transplantation in children?
  2. What are the recent findings about the long-term patient and graft survival rates in pediatric intestinal and multivisceral transplantation?
  3. What are some of the unique pediatric specific surgical challenges in intestinal and multivisceral transplantation?

Doctor’s Tip

One helpful tip a doctor might tell a patient about intestinal transplant is to follow a strict medication regimen to prevent rejection of the transplanted intestine. It is important to take immunosuppressant medications as prescribed and attend all follow-up appointments with your transplant team to monitor your progress and make any necessary adjustments to your treatment plan. Additionally, maintaining a healthy lifestyle, including a balanced diet and regular exercise, can help support the success of the transplant.

Suitable For

Patients who are typically recommended for intestinal transplant are those with irreversible intestinal failure and complications related to parenteral nutrition. This includes children who are unable to tolerate enteral feeds, have complications related to long-term parenteral nutrition, and have failed other medical management options. The etiology of intestinal failure in children may be different from adults, but the evaluation process for transplantation is similar. The indication criteria for pediatric transplantation continues to be updated as advancements in IF management and home parenteral nutrition are made. Pediatric surgical challenges such as abdominal closure and post-transplantation outcomes are also important considerations for transplant candidacy. Overall, intestinal and multivisceral transplants remain a lifesaving treatment for many children with IF, although long-term graft function remains a challenge.

Timeline

Before intestinal transplant:

  • The patient is diagnosed with irreversible intestinal failure and complications related to parenteral nutrition
  • The patient undergoes evaluation for transplantation, including assessing the etiology of the intestinal failure
  • The patient may receive treatment for their condition, such as home parenteral nutrition
  • The patient meets the indication criteria for transplantation
  • The patient may experience surgical challenges, such as abdominal closure

After intestinal transplant:

  • The patient undergoes the transplant surgery
  • The patient receives post-transplant care and monitoring to ensure graft function
  • The patient’s outcomes are monitored, including long-term patient and graft survival
  • The patient may experience improved quality of life post-transplant
  • Long-term graft function remains a challenge for patients undergoing intestinal transplant

What to Ask Your Doctor

  1. What are the indications for intestinal transplant in pediatric patients?
  2. What is the success rate of intestinal transplants in children?
  3. What are the potential risks and complications associated with intestinal transplant surgery?
  4. How long is the recovery process after an intestinal transplant?
  5. What is the long-term prognosis for pediatric patients who undergo an intestinal transplant?
  6. How will the need for immunosuppressive medications impact my child’s daily life and future health?
  7. What kind of follow-up care will be required after the transplant surgery?
  8. Are there any specific dietary restrictions or lifestyle changes that my child will need to follow post-transplant?
  9. How will the transplant team monitor for rejection or other complications after the surgery?
  10. Are there any alternative treatment options that should be considered before proceeding with an intestinal transplant?

Reference

Authors: Maklad M, Mazariegos G, Ganoza A. Journal: Curr Opin Organ Transplant. 2023 Aug 1;28(4):316-325. doi: 10.1097/MOT.0000000000001082. Epub 2023 Jun 12. PMID: 37418582