Garcia Aroz Sandra, Tzvetanov Ivo, Hetterman Elizabeth Anne, Jeon Hoonbae, Oberholzer Jose, Testa Giuliano, John Eunice, Benedetti Enrico
Division of Transplantation, Department of Surgery, University of Illinois, Chicago, IL, USA.
Department of Pharmacy, University of Illinois, Chicago, IL, USA.
Pediatr Transplant. 2017 Jun;21(4). doi: 10.1111/petr.12910. Epub 2017 Mar 12.
Pediatric patients with irreversible intestinal failure present a significant challenge to meet the nutritional needs that promote growth. From 2002 to 2013, 13 living-related small intestinal transplantations were performed in 10 children, with a median age of 18 months. Grafts included isolated living-related intestinal transplantation (n=7), and living-related liver and small intestine (n=6). The immunosuppression protocol consisted of induction with thymoglobulin and maintenance therapy with tacrolimus and steroids. Seven of 10 children are currently alive with a functioning graft and good quality of life. Six of the seven children who are alive have a follow-up longer than 10 years. The average time to initiation of oral diet was 32 days (range, 13-202 days). The median day for ileostomy takedown was 77 (range, 18-224 days). Seven children are on an oral diet, and one of them is on supplements at night through a g-tube. We observed an improvement in growth during the first 3 years post-transplant and progressive weight gain throughout the first year post-transplantation. Growth catch-up and weight gain plateaued after these time periods. We concluded that living donor intestinal transplantation potentially offers a feasible, alternative strategy for long-term treatment of irreversible intestinal failure in children.
