Improved quality of life by combined transplantation in Hirschsprung's disease with a very long aganglionic segment.
OBJECTIVE
The treatment of children with Hirschsprung's disease beginning in the proximal jejunum remains a challenge for the pediatric surgeon. These patients need a definitive parenteral nutrition, which could lead to a liver impairment. The goal of this work is to assess the quality of life after combined liver, intestine, and right colon transplantation.


METHODS
This is a retrospective study of 3 patients. Data regarding symptomatology, radiographic and operating findings, postoperating recovery, and quality of life were analyzed and compared with the quality of life before the transplantation.


RESULTS
The suspicion of a very long intestinal aganglionosis should be derived from the intestinal biopsies. Three combined liver, intestine, and right colon transplantation operations have been performed. The immunosuppression included steroids, tacrolimus, and azathioprine. An abdominal pull-trough (Duhamel procedure 2, Swenson procedure 1) was performed from 6 to 24 months after the transplantation. The follow-up after the transplantation ranges from 2 to 6 years. These 3 patients are completely off total parenteral nutrition with bowel movements 2 to 3 times a day. Two patients are continent day and night, and one is continent during the day only.


CONCLUSIONS
Intestinal transplantation is feasible with good results even when a liver impairment needs a combined intestine and liver transplantation. The right colon transplantation, in our experience, does not impair the results. The quality of life after the transplantation is better than before.
Yann
Revillon
R
Hôpital des enfants Malades, Paris, France.
Yves
Aigrain
A
Dominique
Jan
J
Thierry
Yandza
Y
Olivier
Goulet
G
Florence
Lacaille
L
D003106:Colon / Q000637:transplantation*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006627:Hirschsprung Disease / Q000150:complications / Q000473:pathology / Q000523:psychology / Q000601:surgery*; D006801:Humans; D007081:Ileostomy; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007231:Infant, Newborn; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery; D007422:Intestines / Q000637:transplantation*; D007582:Jejunostomy; D016031:Liver Transplantation; D008297:Male; D011183:Postoperative Complications; D011788:Quality of Life; D012189:Retrospective Studies; D016896:Treatment Outcome
D007166:Immunosuppressive Agents