Kato Tomoaki, Mittal Naveen, Nishida Seigo, Levi David, Yamashiki Noriyo, Miller Barbara, Gonzalez Monica, Ruiz Phillip, Madariaga Juan, Nery Jose, Gelman Barry, Thompson John, Gyamfi Anthony, Tzakis Andreas
Division of Liver and GI Transplant, and Department of Anesthesia, University of Miami, School of Medicine, Miami, FL, USA.
J Pediatr Surg. 2003 Feb;38(2):145-9. doi: 10.1053/jpsu.2003.50033.
BACKGROUND/PURPOSE: Modern neonatal care, surgical treatment, and total parenteral nutrition (TPN) have improved survival rate for babies with extensive gut resections. The authors examined the role of intestinal transplantation in the treatment of these patients.
The authors reviewed all pediatric intestinal transplants performed for short bowel syndrome at our center (70 transplants performed between Aug 1994 and Feb 2002). Factors affecting patient survival were analyzed.
Older patient age at the time of transplant was a significant factor favorably affecting patient survival (P =.031). Trends toward better survival rates were observed in those transplants performed more recently (P =.063), in those patients with greater body weight (P =.084), in those not hospitalized at the time of transplant (P =.14), and in those without concomitant liver failure (P =.12). Three-year survival rate for patients greater than age 2 years and without liver failure was 90%. However, 32% of our recipients underwent transplant at age less than one year, and most in this group (75%) had concomitant liver failure.
For babies with irreversible intestinal failure, intestinal transplantation is a life-saving option. Results, which have recently improved, are best when transplantation compliments more conservative surgical treatments and TPN. However, there is a subset of patients who have liver disease early requiring urgent transplant.
背景/目的：现代新生儿护理、手术治疗和全胃肠外营养（TPN）提高了接受广泛肠道切除手术婴儿的存活率。作者研究了肠道移植在治疗这些患者中的作用。
作者回顾了在我们中心进行的所有因短肠综合征而进行的小儿肠道移植手术（1994年8月至2002年2月期间进行了70例移植手术）。分析了影响患者存活的因素。
移植时患者年龄较大是对患者存活有显著有利影响的因素（P = 0.031）。在最近进行的移植手术患者中（P = 0.063）、体重较大的患者中（P = 0.084）、移植时未住院的患者中（P = 0.14）以及无伴发肝衰竭的患者中（P = 0.12）观察到存活率有提高趋势。2岁以上且无肝衰竭患者的三年存活率为90%。然而，我们32%的受者在1岁以下接受了移植，且该组大多数患者（75%）伴有肝衰竭。
对于患有不可逆肠道衰竭的婴儿，肠道移植是一种挽救生命的选择。当移植与更保守的手术治疗和TPN相结合时，最近有所改善的结果最佳。然而，有一部分患者早期患有肝病，需要紧急移植。
