Intestinal transplantation in children: differences between isolated intestinal and composite grafts.
The results of the isolated intestinal grafts were compared with those of composite grafts (intestinal graft + liver) in a series of 18 transplantations performed in 17 children; 5 isolated intestinal grafts, 12 hepatointestinal grafts, and 1 multivisceral graft. Causes of intestinal failure were short bowel syndrome (n = 13), motility disorders (n = 2) and congenital epithelial disorders (n = 2). Transplantation was indicated due to end-stage liver disease (n = 14), loss of venous access (n = 2), untreatable diarrhea (n = 1) and high morbidity associated with a poor quality of life (n = 1). Six children, all with a composite graft, died after transplantation due to lymphoma (n = 2), sepsis (n = 1); intraabdominal bleeding (n = 1); pneumonia (n = 1); and overwhelming adenoviral infection (n = 1). Digestive autonomy was achieved in 16 of 18 grafts, the 11 surviving children are free of parenteral nutrition with a reasonably good quality of life. In conclusion, intestinal transplantation is a viable therapeutic alternative for children with permanent intestinal failure. The results of transplantation with an isolated intestine are clearly better that those with a composite graft.
López-Santamaría
M
M
Unit of Pediatric Abdominal Organs Transplantation, Department of Pediatric Surgery, Madrid, Spain. mlopez.hulp@salud.madrid.org
Gámez
M
M
Murcia
J
J
Leal
N
N
Hernández
F
F
Tovar
J
J
Frauca
E
E
Camarena
C
C
Hierro
L
L
de la Vega
A
A
Diaz
M
M
Bortolo
G
G
Jara
P
P
Molina
M
M
Sarriá
J
J
Prieto
G
G
D000293:Adolescent; D000328:Adult; D002675:Child, Preschool; D003188:Composite Resins / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007223:Infant; D007410:Intestinal Diseases / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D007422:Intestines / Q000637:transplantation*; D008297:Male; D012778:Short Bowel Syndrome / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D016019:Survival Analysis; D016896:Treatment Outcome
D003188:Composite Resins