Pediatric small bowel transplantation.
OBJECTIVE
Intestine has become a transplantable organ due to the improvement in immunosuppressive drugs. The early referral to a reference unit is crucial in prognosis. There are still some pending issues like chronic rejection, the knowledge of the role of DSA development or early noninvasive detection of acute rejection.


RESULTS
The appearance of tacrolimus and mTOR, and the use of induction therapy have marked a turning point with better graft and patient survival rates. The inclusion of the liver in the graft seems to have a protective effect. Surveillance of opportunistic infections has also contributed to improved results. Infection, post-transplant lymphoproliferative disease, rejection and GVHD have still a major role in survival; however, antibody-mediated rejection has gained increased attention.


CONCLUSIONS
Parenteral nutrition remains the main therapeutic resource in the management of intestinal failure, but intestinal transplant is a therapeutic option when this therapy has failed. Finding the balanced immunosuppression that minimizes risk of rejection while preventing occurrence of complications like post-transplant lymphoproliferative disease or GVHD is an ongoing challenge. The current survival rates of intestinal transplantation are similar to other solid organ transplant.
Pediatric Gastroenterology Intestinal Rehabilitation Unit, University Pediatric Hospital La Paz, Paseo de la Castellana, Madrid, Spain.
Esther Ramos
ER
Boluda
D000818:Animals; D002648:Child; D006084:Graft Rejection / Q000517:prevention & control; D006086:Graft vs Host Disease / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007421:Intestine, Small / Q000637:transplantation*; D058570:TOR Serine-Threonine Kinases / Q000378:metabolism; D016559:Tacrolimus / Q000627:therapeutic use
D007166:Immunosuppressive Agents; D058570:TOR Serine-Threonine Kinases; D016559:Tacrolimus