Our Summary

This research paper discusses an organization’s model for conducting liver transplants, particularly in children. Annually, they can perform 1,000 liver transplants, with 5% being on children. These transplants have a high success rate, with 90% of children surviving the first year and 80% surviving 15 years or more. The primary reason for these transplants is a disease called biliary atresia, followed by metabolic liver disease and acute liver failure.

Most of the transplants are performed on children under two years old, with a quarter to a third happening in the first year of life. There’s a waiting list of about 35 patients, with an average of 100 new patients added each year. Out of these, around 60 get transplanted after waiting for about 136 days.

To decide who gets a transplant first, they use a system called PELD. However, there’s a growing problem because the people donating livers are getting older, and their livers don’t always match the needs of the young patients on the waiting list. To combat this issue, the organization is using strategies like living donor liver transplants and split liver transplants. These can increase the chances of a successful transplant and reduce waiting times and the number of deaths on the waiting list.

The paper also mentions that intestinal transplants in children are less common, but have very strict requirements. Due to these limitations, and lack of alternative solutions, the chances of a successful transplant for these patients are lower.

FAQs

  1. What is the average survival rate after a year and after 15 years for children who have undergone liver transplants?
  2. What strategies are used to increase the probability of a transplant while simultaneously reducing both time and mortality on the waiting list?
  3. What are the challenges and difficulties encountered with pediatric intestinal transplantation?

Doctor’s Tip

A doctor might tell a patient considering an intestinal transplant that it is a complex procedure with strict requirements for both the patient and donor. They may also explain that due to the rarity of suitable donors, the chances of receiving a transplant may be lower compared to other types of organ transplants. It is important for the patient to fully understand the risks and benefits of the procedure and to follow their doctor’s recommendations closely throughout the transplant process.

Suitable For

Patients who are typically recommended for intestinal transplant are those with severe, progressive, and irreversible intestinal diseases that have failed to respond to other forms of treatment. These patients may suffer from conditions such as short bowel syndrome, intestinal failure, or certain genetic disorders that affect the intestines. Intestinal transplantation may be considered as a treatment option when other interventions, such as parenteral nutrition or bowel lengthening procedures, have been unsuccessful in improving the patient’s quality of life and overall health. Additionally, patients who have experienced complications from previous intestinal surgeries or have developed life-threatening complications from their underlying intestinal disease may also be candidates for intestinal transplant.

Timeline

  • Before intestinal transplant:
  1. Patient is diagnosed with severe, progressive, and irreversible liver disease or other conditions that may require intestinal transplant.
  2. Patient is placed on the waiting list for a suitable donor organ.
  3. Patient may undergo various medical treatments and interventions to manage their condition while waiting for a transplant.
  4. Patient and their family undergo counseling and education about the transplant process and potential risks and benefits.
  • After intestinal transplant:
  1. Patient undergoes the transplant surgery, which may involve transplanting the small intestine, large intestine, and other organs such as the liver or pancreas.
  2. Patient is closely monitored in the intensive care unit post-transplant to monitor for any complications or rejection.
  3. Patient begins a lifelong regimen of immunosuppressive medications to prevent rejection of the transplanted organ.
  4. Patient undergoes regular follow-up appointments with their transplant team to monitor their progress and adjust medications as needed.
  5. Patient may experience complications such as infections, rejection episodes, or side effects from medications, which require ongoing management.
  6. Over time, patient gradually recovers and is able to resume normal activities, with the goal of improving their quality of life and overall health.

What to Ask Your Doctor

  1. What is the success rate of intestinal transplants in pediatric patients compared to adult patients?

  2. What are the potential risks and complications associated with intestinal transplantation?

  3. How long is the recovery process after an intestinal transplant and what can be expected during the recovery period?

  4. What is the long-term prognosis for pediatric patients who undergo an intestinal transplant?

  5. Are there any alternative treatments or therapies that could be considered before opting for an intestinal transplant?

  6. How will medications and follow-up care be managed after the transplant?

  7. What is the process for finding a suitable donor for an intestinal transplant in pediatric patients?

  8. How does the prioritization process work for pediatric patients on the waiting list for an intestinal transplant?

  9. Are there any specific dietary or lifestyle changes that will need to be made after an intestinal transplant?

  10. What support services are available for pediatric patients and their families before, during, and after an intestinal transplant procedure?

Reference

Authors: de la Rosa G, Matesanz R. Journal: An Pediatr (Barc). 2015 Dec;83(6):441.e1-8. doi: 10.1016/j.anpedi.2015.11.001. Epub 2015 Nov 21. PMID: 26611879