title: Long-term outcome, growth and digestive function in children 2 to 18 years after intestinal transplantation.
abstract: OBJECTIVE
  Small bowel (SB) transplantation (Tx), long considered a rescue therapy for patients with intestinal failure, is now a well recognised alternative treatment strategy to parental nutrition (PN). In this retrospective study, we analysed graft functions in 31 children after SBTx with a follow-up of 2-18 years (median 7 years).
  
  
  METHODS
  Twelve children had isolated SBTx, 19 had combined liver-SBTx and 17 received an additional colon graft. Growth, nutritional markers, stool balance studies, endoscopy and graft histology were recorded every 2-3 years post-Tx.
  
  
  RESULTS
  All children were weaned from PN after Tx and 26 children remained PN-free. Enteral nutrition was required for 14/31 (45%) patients at 2 years post-Tx. All children had high dietary energy intakes. The degree of steatorrhoea was fairly constant, with fat and energy absorption rates of 84-89%. Growth parameters revealed at transplantation a mean height Z-score of -1.17. After Tx, two-thirds of children had normal growth, whereas in one-third, Z-scores remained lower than -2, concomitant to a delayed puberty. Adult height was normal in 5/6. Endoscopy and histology analyses were normal in asymptomatic patients. Chronic rejection occurred only in non-compliant patients. Five intestinal grafts were removed 2.5-8 years post-Tx for acute or chronic rejection.
  
  
  CONCLUSIONS
  This series indicates that long-term intestinal autonomy for up to 18 years is possible in the majority of patients after SBTx. Subnormal energy absorption and moderate steatorrhoea were often compensated for by hyperphagia, allowing normal growth and attainment of adult height. Long-term compliance is an important pre-requisite for long-term graft function.
authors: Pediatric Gastroenterology-Hepatology-Nutrition Unit, Necker-Enfants malades Hospital, 149 rue de Sèvres, 75015 Paris, France. florence.lacaille@nck.aphp.fr
authors: F
authors: F
authors: Lacaille
authors: N
authors: N
authors: Vass
authors: F
authors: F
authors: Sauvat
authors: D
authors: D
authors: Canioni
authors: V
authors: V
authors: Colomb
authors: C
authors: C
authors: Talbotec
authors: N Patey-Mariaud
authors: NP
authors: De Serre
authors: J
authors: J
authors: Salomon
authors: J-P
authors: JP
authors: Hugot
authors: J-P
authors: JP
authors: Cézard
authors: Y
authors: Y
authors: Révillon
authors: F M
authors: FM
authors: Ruemmele
authors: O
authors: O
authors: Goulet
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D004063:Digestion; D004750:Enteral Nutrition / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000473:pathology; D006128:Growth; D006801:Humans; D007082:Ileum / Q000473:pathology; D007410:Intestinal Diseases / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D007413:Intestinal Mucosa / Q000473:pathology; D007422:Intestines / Q000637:transplantation*; D008297:Male; D009752:Nutritional Status; D010288:Parenteral Nutrition / Q000379:methods; D012189:Retrospective Studies; D012778:Short Bowel Syndrome / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers