Our Summary

This research paper is a review of the state of child intestinal transplants in the United States. Over 1500 of these transplants have been done since 1985, but recently, less than 50 are done each year. This drop in numbers is largely due to the fact that the success rates of these transplants haven’t improved much over time, and treatments to help the intestine recover without needing a transplant have gotten better.

Currently, about 68% of transplants are still working after one year, and about half are still working after five years. However, some medical centers that do a lot of these transplants have seen better results. The most common cause of death after a transplant is severe infection, while the most common reason the transplant fails is because the body rejects it.

There are also some long-term complications to watch out for, like chronic kidney disease and a condition where the immune cells grow too much after the transplant. Most children who get these transplants need strong medicine to prevent their bodies from rejecting the transplant, and usually need additional feeding through a tube, even if they are not on parenteral nutrition anymore. In addition, many of these children need special education, and some have reported lower quality of life in certain aspects.

In conclusion, while there is room for improvement in the success rates of child intestinal transplants, there have been successful outcomes especially in medical centers with a lot of experience in the procedure. As treatments that help the intestine recover continue to improve, it’s likely that the number of these transplants will continue to decrease.

FAQs

  1. How many pediatric intestinal transplants have been performed in the United States since 1985?
  2. What are some of the leading causes of death and graft loss following pediatric intestinal transplants?
  3. What are the current trends and future implications in the field of pediatric intestinal transplantation?

Doctor’s Tip

One helpful tip a doctor might tell a patient about intestinal transplant is to closely follow the prescribed immunosuppressive medication regimen to prevent rejection of the transplanted organ. It is also important to attend all follow-up appointments and communicate any changes in symptoms or health status to the medical team. Additionally, maintaining a healthy lifestyle, including a balanced diet and regular exercise, can help support overall well-being and the success of the transplant.

Suitable For

Patients who are typically recommended for intestinal transplant are those who have irreversible intestinal failure and are unable to tolerate or benefit from conventional medical or surgical treatments. This may include patients with conditions such as short bowel syndrome, intestinal motility disorders, congenital abnormalities of the intestines, and complications from previous surgeries. Patients who are at risk of severe complications such as liver failure, recurrent infections, or malnutrition may also be considered for intestinal transplant. It is important for patients to undergo a thorough evaluation by a multidisciplinary team of specialists to determine their eligibility for transplant and to assess their overall health and ability to withstand the transplant procedure and post-transplant care.

Timeline

Before Intestinal Transplant:

  • Patient experiences chronic intestinal failure, often requiring long-term parenteral nutrition
  • Patient may also experience complications such as infections, liver dysfunction, and poor quality of life
  • Patient undergoes extensive evaluation to determine eligibility for intestinal transplant, including physical exams, imaging studies, and psychological assessments

After Intestinal Transplant:

  • Patient undergoes surgery to receive a new intestine, often combined with other organs such as the liver or pancreas
  • Patient is placed on immunosuppressive medications to prevent rejection of the transplanted organ
  • Patient may experience complications such as rejection, infection, and side effects from medications
  • Patient requires close monitoring and follow-up care to ensure the success of the transplant
  • Patient may gradually be weaned off of parenteral nutrition and regain normal intestinal function
  • Patient may experience improved quality of life and overall health outcomes following a successful transplant.

What to Ask Your Doctor

  1. What is the success rate of intestinal transplants in pediatric patients?
  2. What are the potential risks and complications associated with intestinal transplant surgery?
  3. How long is the recovery process after an intestinal transplant?
  4. What type of follow-up care will be needed after the transplant surgery?
  5. Are there any specific dietary restrictions or recommendations that need to be followed post-transplant?
  6. How will the transplant affect the patient’s quality of life in the long term?
  7. What medications will the patient need to take after the transplant, and what are the potential side effects?
  8. How often will the patient need to come in for check-ups and monitoring after the transplant?
  9. What criteria are used to determine if a patient is a suitable candidate for an intestinal transplant?
  10. Are there any alternative treatments or therapies that could be considered before opting for an intestinal transplant?

Reference

Authors: Venick RS, Duggan E, Whatley J. Journal: Curr Opin Organ Transplant. 2020 Apr;25(2):201-207. doi: 10.1097/MOT.0000000000000744. PMID: 32073484