title: Life-threatening risk factors and the role of intestinal transplantation in patients with intestinal failure.
abstract: OBJECTIVE
  We elucidated the life-threatening risk factors for intestinal failure (IF) and characterized the role of intestinal transplantation (ITx) in affected patients.
  
  
  METHODS
  We conducted a retrospective review of 38 patients with short bowel (SB) and 19 with motility disorders (MD). The SB patients were divided into three categories according to the length of their residual small bowel and the presence of the ileocecal valve. The four disease subcategories were grouped into two categories: low-risk category (mild and moderated SB) and high-risk category (extensive SB and MD). The age at the introduction of parenteral nutrition (PN) was <1 year in 50 patients (infant group, IG) and 1-15 years in 7 patients (pediatric group, PG).
  
  
  RESULTS
  Enteral autonomy was rarely achieved in the high-risk category (p < 0.0001). IG was associated with a higher incidence of developing intestinal failure-associated liver disease (IFALD) (p = 0.004). Eight patients died, due to IFALD in four, sepsis in three and acute heart failure in one. Twenty-eight patients (49 %) are currently alive without PN, including four after ITx.
  
  
  CONCLUSIONS
  The treatment of high-risk IF is still challenging. Inclusion of ITx in appropriate timing, along with aggressive medical, nutritional and surgical management, may reduce advanced morbidity and mortality of high-risk IF.
authors: Department of Pediatric Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan, wada@ped-surg.med.tohoku.ac.jp.
authors: Motoshi
authors: M
authors: Wada
authors: Kotaro
authors: K
authors: Nishi
authors: Megumi
authors: M
authors: Nakamura
authors: Hironori
authors: H
authors: Kudo
authors: Satoshi
authors: S
authors: Yamaki
authors: Hideyuki
authors: H
authors: Sasaki
authors: Tomoyuki
authors: T
authors: Sato
authors: Taichi
authors: T
authors: Fukuzawa
authors: Hiromu
authors: H
authors: Tanaka
authors: Takuro
authors: T
authors: Kazama
authors: Shintaro
authors: S
authors: Amae
authors: Masaki
authors: M
authors: Nio
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007410:Intestinal Diseases / Q000453:epidemiology / Q000601:surgery*; D007422:Intestines / Q000637:transplantation*; D007564:Japan / Q000453:epidemiology; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
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