Transplant Services, Seattle Children's Hospital, Seattle, WA 98105, USA.
J Pediatr Surg. 2014 Jan;49(1):13-8. doi: 10.1016/j.jpedsurg.2013.09.022. Epub 2013 Oct 5.
The development of pediatric intestine transplantation has required continuous refinements in the management of intestinal failure, surgical technique, and perioperative care. The development of better immunosuppressive management (cyclosporine in 1978 and tacrolimus in 1989) and enhancements in our understanding of the relationship between recipient and host immune systems have resulted in better long-term survival. Paralleling this, advancements in the organ procurement techniques and organ preservation solutions have made possible the procurement and transplantation of various types of intestine containing grafts tailored to the needs of the various indications for which intestine transplantation is being performed. With improved outcomes, the indications for intestine transplantation have been better defined in the context of risk benefit for the most important complications of TPN, which include liver disease, life threatening infection, and loss of central venous access. The first survivors of transplantation would also go on to demonstrate the interaction (host-versus-graft and graft-versus-host) between recipient and donor immunocytes (brought with the allograft), which under the cover of immunosuppression allows varying degrees of graft acceptance. The struggle to achieve better transplantation survival outcomes came about with the development of improved strategies to better manage intestinal failure. This has been accomplished largely through the establishment of centers that incorporate a multidisciplinary team approach to medical and surgical care. Intestine transplantation represents a lifesaving therapy for many patients with intestinal failure who have significant complications of their disease. It is hoped that with the minimization of immunosuppression strategies currently used, the long-term survival of these intestine organ transplant recipients will continue improving, together with their rehabilitation and quality-of-life.
儿科肠移植的发展需要不断完善肠衰竭的管理、手术技术和围手术期护理。更好的免疫抑制管理（1978 年环孢素和 1989 年他克莫司）的发展以及我们对受者和宿主免疫系统之间关系的理解的增强，导致了更好的长期生存。与此并行的是，器官获取技术和器官保存解决方案的进步，使得可以获取和移植各种类型的肠，这些肠包含根据肠移植的各种适应证定制的移植物。随着结果的改善，肠移植的适应证在 TPN 最严重并发症的风险获益方面得到了更好的定义，这些并发症包括肝病、危及生命的感染和中心静脉通路丧失。移植的第一批幸存者也将继续展示受者和供者免疫细胞（随同种异体移植物而来）之间的相互作用（宿主-移植物和移植物-宿主），在免疫抑制的掩盖下，允许移植物接受不同程度的接受。为了实现更好的移植生存结果，我们通过开发更好的策略来更好地管理肠衰竭。这主要是通过建立多学科团队方法来进行医疗和外科护理的中心来实现的。肠移植是许多患有严重疾病并发症的肠衰竭患者的救生疗法。希望随着目前使用的免疫抑制策略的最小化，这些肠器官移植受者的长期生存将继续改善，同时改善他们的康复和生活质量。
