Our Summary

This research paper is about a study conducted on children who received a transplant, specifically intestinal, liver, and renal transplants. The researchers wanted to observe the occurrence of delirium, a state of mental confusion and emotional disturbance, in these children immediately after their transplant surgery. They collected data from 211 children who underwent these surgeries in a high-volume transplant center from 2016 to 2022.

They discovered that delirium was quite common, especially in children who had received an intestinal or liver transplant. About 80% of children who received intestinal transplants and 75% of those who received liver transplants showed signs of delirium. On the other hand, only 14% of children who received kidney transplants experienced delirium.

The study also found that younger children, those who needed ventilators for a longer time after surgery, and those who stayed longer in the pediatric intensive care unit (PICU) were more likely to experience delirium. The researchers also noted that deep sedation, agitation, and significant withdrawal symptoms from medication were also linked to a positive screen for delirium.

In summary, this study shows that delirium is quite common in children after intestinal and liver transplant surgeries, and it’s associated with factors like the child’s age, length of stay in the PICU, and other symptoms like agitation and medication withdrawal.

FAQs

  1. What percentage of children experienced delirium after receiving an intestinal or liver transplant according to the study?
  2. What factors were found to be associated with a higher likelihood of experiencing delirium post-transplant surgery in children?
  3. Was delirium common in children who received kidney transplants in this study?

Doctor’s Tip

A helpful tip a doctor might give to a patient about intestinal transplant is to be aware of the possibility of delirium post-surgery, especially in children. They should understand that delirium is a common occurrence in this population and can be influenced by factors such as age, length of stay in the PICU, and symptoms like agitation and medication withdrawal. Patients should be prepared to work closely with their healthcare team to manage and treat any episodes of delirium that may occur, and to ensure the best possible outcome for their recovery.

Suitable For

Patients who are typically recommended for intestinal transplant are those who have irreversible intestinal failure, meaning they are unable to absorb nutrients and fluids properly despite medical treatment. This can be due to conditions such as short bowel syndrome, intestinal motility disorders, or severe intestinal damage from trauma or infection.

Patients who may be considered for an intestinal transplant include those who are dependent on parenteral nutrition (intravenous feeding) due to their intestinal failure, have frequent complications from their underlying condition, or have a poor quality of life due to their inability to eat or drink normally.

In addition, patients who have failed other treatments for their intestinal failure, such as surgery or medications, may also be candidates for an intestinal transplant. The decision to recommend an intestinal transplant is typically made by a multidisciplinary team of specialists, including transplant surgeons, gastroenterologists, nutritionists, and social workers, who assess the patient’s medical history, current condition, and likelihood of benefiting from a transplant.

Timeline

Before the intestinal transplant:

  • Patient undergoes extensive medical evaluation to determine the need for a transplant
  • Patient is placed on the transplant waiting list and waits for a suitable donor
  • Patient may experience symptoms related to their intestinal failure, such as malnutrition, dehydration, and frequent infections
  • Patient may require parenteral nutrition or intravenous fluids to maintain their nutrition and hydration status

After the intestinal transplant:

  • Patient undergoes the transplant surgery, which can last several hours
  • Patient is closely monitored in the intensive care unit (ICU) immediately after surgery
  • Patient may experience complications such as organ rejection, infection, or complications related to the surgery
  • Patient may need to stay in the hospital for an extended period of time for monitoring and recovery
  • Patient undergoes rehabilitation and physical therapy to regain strength and function
  • Patient requires lifelong immunosuppressant medication to prevent organ rejection
  • Patient undergoes regular follow-up appointments with their transplant team to monitor their progress and adjust their treatment plan as needed.

What to Ask Your Doctor

Some questions a patient should ask their doctor about intestinal transplant include:

  1. What are the risks and potential complications associated with an intestinal transplant?
  2. How long is the recovery process after an intestinal transplant surgery?
  3. How will the transplant impact my daily life and activities?
  4. What kind of follow-up care and monitoring will be required after the transplant?
  5. Are there any specific dietary restrictions or guidelines I need to follow post-transplant?
  6. What medications will I need to take after the transplant, and what are the potential side effects?
  7. How long can I expect the transplanted intestine to function effectively?
  8. What signs or symptoms should I watch out for that may indicate rejection or other issues with the transplant?
  9. Will I need to make any lifestyle changes or adjustments to support the success of the transplant?
  10. Are there any support groups or resources available for patients who have undergone an intestinal transplant?

Reference

Authors: Patel S, Pfeiffer B, Haddock De Jesus R, Garcia J, Chandar J, Alladin A. Journal: Pediatr Crit Care Med. 2024 Sep 1;25(9):838-847. doi: 10.1097/PCC.0000000000003540. Epub 2024 May 28. PMID: 38801303