PRELIMINARY EXPERIENCE WITH INTESTINAL TRANSPLANTATION IN INFANTS ANDCHILDREN

Objective. This report discusses the preliminary experience with intes tinal transplantation in children at the University of Nebraska Medica l Center. Patients. During the past 4 years, 16 intestinal transplants have been performed in infants and children. Thirteen have been combi ned liver and bowel transplants, and the remainder were isolated intes tinal transplants. Nearly half of the patients were younger than 1 yea r of age at the time of surgery, and the vast majority were younger th an 5 years of age. All but one had short bowel syndrome. Results. The 1-year actuarial patient and graft survival rates for recipients of li ver and small bowel transplants were 76% and 61%, respectively. Eight of 13 patients who received liver and small bowel transplants remain a live at the time of this writing, with a mean length of follow-up of 2 63 (range, 7 to 1223) days. Six patients are currently free of total p arenteral nutrition. All three patients receiving isolated intestinal transplants are alive and free of parenteral nutrition. The mean lengt h of follow-up is 384 (range, 330 to 450) days. Major complications ha ve included severe infections and rejection. Lymphoproliferative disea se, graft-versus-host disease, and chylous ascites have not been major problems. Conclusions. Although intestinal transplantation is in its infancy, these preliminary results suggest combined liver and bowel tr ansplants and isolated intestinal transplantation may be viable option s for some patients with intestinal failure caused by short bowel synd rome or other gastrointestinal disease in whom long-term total parente ral nutrition is not an attractive option.