Pediatric small bowel transplantation

• Published in: Seminars in pediatric surgery Vol. 19; no. 1; pp. 68 - 77
• Main Authors: Nayyar, Navdeep, MD, Mazariegos, George, MD, Ranganathan, Sarangarajan, MD, Soltys, Kyle, MD, Bond, Geoffrey, MD, Jaffe, Ronald, MD, Sun, Qing, MS, Nucci, Anita, PhD, Kosmach, Beverly, MSN, Squires, Robert, MD, Abu-Elmagd, Kareem, MD, PhD, Sindhi, Rakesh, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2010
• Subjects: Child; Children; Graft Rejection - diagnosis; Graft Rejection - therapy; Humans; Intestine, Small - blood supply; Intestine, Small - transplantation; Patient Selection; Pediatrics; Postoperative Complications; Preoperative Care; Short Bowel Syndrome - diagnosis; Short Bowel Syndrome - surgery; Short gut syndrome; Small bowel transplantation; Surgery; Tissue and Organ Harvesting - methods; Transplantation Conditioning; Short gut syndrome; Small bowel transplantation; Children
• ISSN: 1055-8586; 1532-9453
• DOI: 10.1053/j.sempedsurg.2009.11.009

The multivisceral liver-intestine-pancreas-stomach allograft was first described by Starzl nearly 50 years ago. Since then, over 1000 children have received small bowel transplantation (SBTx), alone or with the liver and other organs, for refractory short gut syndrome (SGS) because of a variety of congenital conditions. In 2001, SBTx was approved as definitive therapy for SGS by Medicare. Currently, 1- and 5-year graft survival routinely exceeds 90% and 80%, respectively. The expected outcomes also include freedom from parenteral nutrition, normalization of growth parameters, and quality of life. However, recurrent rejection, complications of high-dose immunosuppression, or chronic rejection, which is more likely to occur after SBTx without a liver graft, account for differences between early and late survival. Future efforts aimed at overcoming such challenges include preventing SBTx through early referral to comprehensive SGS management programs and understanding why the liver protects the small bowel allograft from rejection. Finally, inflammatory mechanisms, which predispose the highly immunogenic small bowel allograft to a protracted risk of resistant rejection must be elucidated, in order to ensure durable success.