title: New perspectives for children with microvillous inclusion disease: early small bowel transplantation.
abstract: BACKGROUND
  Microvillous inclusion disease (MVID) is a congenital intestinal epithelial cell disorder leading to lifelong intestinal failure. Despite long-term total parenteral nutrition, life expectancy is extremely reduced because of metabolic or septic complications or liver failure.
  
  
  METHODS
  Twelve patients with early-onset MVID were evaluated between 1995 and 2002 for the possibility of small bowel transplantation (SbTx). Three patients died before they could be placed on the waiting list for SbTx, and one patient is still awaiting SbTx. SbTx was contraindicated in one patient.
  
  
  RESULTS
  Seven of 12 patients (six boys and one girl) underwent transplantation (three SbTxs and four combined liver-SbTxs). Actuarial survival rates were 100% and 75% in the SbTx and combined liver-SbTx groups, respectively, with a mean follow-up of 3 years (1.1-8.5 years). In contrast, the survival rate was only 40% in the subgroup of five patients who did not undergo transplantation. After transplantation, all patients were weaned from parenteral nutrition: the five patients with an additional colon graft were weaned within 36 days as opposed to the others without colonic transplant who obtained full intestinal autonomy several months after transplantation. The only two surviving patients who did not undergo SbTx remain highly dependent on total parenteral nutrition, which is complicated by repeated episodes of metabolic decompensation.
  
  
  CONCLUSIONS
  SbTx alone or in combination with the liver is highly successful in children with MVID, offering them a long-term perspective for the first time. Associated colon grafting markedly improves the outcome and quality of life after SbTx in patients with MVID.
authors.affiliation: Combined Program of Liver and Intestinal Transplantation, Hôpital Necker-Enfants Malades, Paris, France. frank.ruemmele@nck.ap-hop-paris.fr.
authors.forename: Frank M
authors.initials: FM
authors.lastname: Ruemmele
authors.forename: Dominique
authors.initials: D
authors.lastname: Jan
authors.forename: Florence
authors.initials: F
authors.lastname: Lacaille
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Cézard
authors.forename: Danielle
authors.initials: D
authors.lastname: Canioni
authors.forename: Alan D
authors.initials: AD
authors.lastname: Phillips
authors.forename: Michel
authors.initials: M
authors.lastname: Peuchmaur
authors.forename: Yves
authors.initials: Y
authors.lastname: Aigrain
authors.forename: Nicole
authors.initials: N
authors.lastname: Brousse
authors.forename: Jacques
authors.initials: J
authors.lastname: Schmitz
authors.forename: Yann
authors.initials: Y
authors.lastname: Revillon
authors.forename: Oliver
authors.initials: O
authors.lastname: Goulet
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000209:etiology; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000209:etiology; D006801:Humans; D007223:Infant; D007410:Intestinal Diseases / Q000473:pathology / Q000601:surgery*; D007413:Intestinal Mucosa / Q000473:pathology*; D007421:Intestine, Small / Q000637:transplantation*; D008297:Male; D008871:Microvilli / Q000473:pathology*