Our Summary
This research paper discusses an issue common in children who have had an intestinal transplant. This operation can be successful for children with intestinal failure, but it also comes with many possible complications. One of these is PTLD, a type of cancer that is quite diverse and can be fatal.
PTLD is especially challenging to manage because the transplanted intestine is prone to rejection, requiring high levels of immunosuppression - which is a factor that can lead to PTLD. The Epstein-Barr virus (EBV) is known to play a role in causing this disease, but another likely factor is the immature immune system of children.
As a result, children who have had an intestinal transplant have a higher risk of developing PTLD than recipients of other organ transplants. There are other risk factors that can lead to PTLD, such as certain molecular and genomic changes, but these aren’t fully understood yet - especially in children.
While research on adults has begun to describe the molecular causes of PTLD, the exact nature of this cancer in children who have had an intestinal transplant is still largely unknown. This paper reviews what is currently known about PTLD in these children and points out areas where more research is needed.
FAQs
- What is PTLD and how often does it occur after intestinal transplantation?
- What factors contribute to a higher risk of developing PTLD in pediatric intestine recipients?
- What is currently known about the molecular and genomic changes that contribute to PTLD development in children who have undergone an intestinal transplant?
Doctor’s Tip
One important tip that a doctor might give a patient who has undergone an intestinal transplant is to closely monitor for any signs or symptoms of post-transplant lymphoproliferative disorder (PTLD). This is a serious complication that can occur after intestinal transplantation and requires prompt medical attention. Patients should be aware of the potential risks and be proactive in seeking medical help if they experience any concerning symptoms. Regular follow-up appointments with healthcare providers are also crucial to monitor for any potential complications and ensure optimal health outcomes.
Suitable For
Patients who are typically recommended for intestinal transplant are those with intestinal failure, often resulting from conditions such as short bowel syndrome, necrotizing enterocolitis, or motility disorders. These patients are unable to absorb enough nutrients from food and may require long-term parenteral nutrition. Intestinal transplantation may be considered when other treatments, such as bowel lengthening procedures or bowel rehabilitation programs, have been unsuccessful.
In particular, pediatric patients with intestinal failure who have severe complications, such as liver failure due to parenteral nutrition-associated liver disease, are candidates for intestinal transplant. Intestinal transplantation may also be recommended for patients with recurrent infections, central line complications, or poor quality of life due to their intestinal failure.
It is important to note that intestinal transplantation is a complex procedure with potential risks and complications, including rejection, infection, and post-transplant lymphoproliferative disorder (PTLD). Patients who are recommended for intestinal transplant should be carefully evaluated by a multidisciplinary team of healthcare providers to determine if they are suitable candidates for the procedure.
Timeline
- Before intestinal transplant:
- Patient is diagnosed with intestinal failure, often due to conditions such as short bowel syndrome or inflammatory bowel disease.
- Patient undergoes extensive medical evaluations and tests to determine eligibility for transplant.
- Patient is placed on the waiting list for a suitable donor intestine.
- Patient may experience complications related to their underlying condition, such as malnutrition or infections, while waiting for transplant.
- After intestinal transplant:
- Patient undergoes the transplant surgery, which may involve removing the entire intestine or a portion of it and replacing it with a donor intestine.
- Patient is closely monitored in the hospital for signs of rejection or complications.
- Patient requires lifelong immunosuppressive medication to prevent rejection of the transplanted intestine.
- Patient undergoes regular follow-up appointments and tests to monitor the health of the transplanted intestine and overall well-being.
- Patient may experience complications related to the transplant, such as infections, rejection episodes, or post-transplant lymphoproliferative disorder (PTLD).
- Patient may need additional surgeries or interventions to address complications or improve the function of the transplanted intestine.
- Patient gradually resumes a normal diet and lifestyle, with the goal of achieving better health and quality of life than before the transplant.
What to Ask Your Doctor
- What are the potential complications of intestinal transplant surgery?
- What is the risk of developing post-transplant lymphoproliferative disorder (PTLD) after an intestinal transplant?
- What are the symptoms of PTLD and how is it diagnosed?
- How is PTLD treated in pediatric intestinal transplant patients?
- What is the role of immunosuppression in increasing the risk of PTLD?
- Are there any specific risk factors or markers that increase the likelihood of developing PTLD in pediatric patients?
- How often should pediatric intestinal transplant patients be monitored for PTLD?
- Are there any preventive measures that can be taken to reduce the risk of developing PTLD?
- What is the prognosis for pediatric patients who develop PTLD after an intestinal transplant?
- Are there any ongoing research studies or clinical trials focused on PTLD in pediatric intestinal transplant patients?
Reference
Authors: Stanley K, Friehling E, Ranganathan S, Mazariegos G, McAllister-Lucas LM, Sindhi R. Journal: Pediatr Transplant. 2018 Aug;22(5):e13211. doi: 10.1111/petr.13211. Epub 2018 May 10. PMID: 29745058