Langnas A N, Shaw B W, Antonson D L, Kaufman S S, Mack D R, Heffron T G, Fox I J, Vanderhoof J A
Department of Surgery and Pediatrics, University of Nebraska Medical Center, Omaha, USA.
Pediatrics. 1996 Apr;97(4):443-8.
This report discusses the preliminary experience with intestinal transplantation in children at the University of Nebraska Medical Center.
During the past 4 years, 16 intestinal transplants have been performed in infants and children. Thirteen have been combined liver and bowel transplants, and the reminder were isolated intestinal transplants. Nearly half of the patients were younger than 1 year of age at the time of surgery, and the vast majority were younger than 5 years of age. All but one had short bowel syndrome.
The 1-year actuarial patient and graft survival rates for recipients of liver and small bowel transplants were 76% and 61%, respectively. Eight of 13 patients who received liver and small bowel transplants remain alive at the time of this writing, with a mean length of follow-up of 263 (range, 7 to 1223) days. Six patients are currently free of total parenteral nutrition. All three patients receiving isolated intestinal transplants are alive and free of parenteral nutrition. The mean length of follow-up is 384 (range, 330 to 450) days. Major complications have included severe infections and rejection. Lymphoproliferative disease, graft-versus-host disease, and chylous ascites have not been major problems.
Although intestinal transplantation is in its infancy, these preliminary results suggest combined liver and bowel transplants and isolated intestinal transplantation may be viable options for some patients with intestinal failure caused by short bowel syndrome or other gastrointestinal disease in whom long-term total parenteral nutrition is not an attractive option.
本报告讨论了内布拉斯加大学医学中心儿童肠移植的初步经验。
在过去4年中，对婴儿和儿童进行了16例肠移植手术。其中13例为肝肠联合移植，其余为单纯肠移植。近一半的患者在手术时年龄小于1岁，绝大多数患者年龄小于5岁。除1例患者外，所有患者均患有短肠综合征。
肝小肠移植受者的1年预期患者生存率和移植物生存率分别为76%和61%。在撰写本文时，13例接受肝小肠移植的患者中有8例仍存活，平均随访时间为263天（范围7至1223天）。6例患者目前已无需全胃肠外营养。接受单纯肠移植的3例患者均存活且无需胃肠外营养。平均随访时间为384天（范围330至450天）。主要并发症包括严重感染和排斥反应。淋巴增生性疾病、移植物抗宿主病和乳糜性腹水并非主要问题。
尽管肠移植尚处于起步阶段，但这些初步结果表明，对于一些因短肠综合征或其他胃肠道疾病导致肠衰竭且长期全胃肠外营养并非理想选择的患者，肝肠联合移植和单纯肠移植可能是可行的选择。
