Long-term outcome, growth and digestive function in children 2 to 18 years after intestinal transplantation

Florence LACAILLE ^1*, Noemi VASS ¹, Frédérique SAUVAT ¹, Danielle CANIONI ¹, Virginie COLOMB ¹, Cécile TALBOTEC ¹, Natacha PATEY-MARIAUD DE SERRE ¹, Julie SALOMON ¹, Jean-Pierre HUGOT ², Jean-Pierre CEZARD ², Yann REVILLON ¹, Frank M RUEMMELE ¹ and Olivier GOULET ¹

¹ Necker-Enfants malades Hospital, France
² Robert-Debré Hospital, France

^* To whom correspondence should be addressed. E-mail: florence.lacaille{at}nck.aphp.fr.

Accepted 16 November 2007

Abstract

Objective:<br> Small bowel transplantation (SBTx), long-time considered as rescue therapy for patients with intestinal failure, is now a well recognized alternative treatment strategy to parental nutrition (PN). In this retro-spective study, we analyzed graft functions in thirty-one children after SBTx with a follow-up of 2-18 years (median 7).

Patients:<br> Twelve children had isolated SB Tx, 19 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:<br> 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 caloric food intakes. Steatorrhea was quasi-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, 2/3 of children had normal growth, whereas in 1/3, 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 was discovered only in non-compliant patients. Five intestinal grafts were removed 2.5-8 years post-Tx for acute or chronic rejection. Conclusions:<br> This series indicates that long-term intestinal autonomy over up to 18 years is possible in the majority of patients after SBTx. Subnormal energy absorption rates and moderate steatorrhea were most often compensated by hyperphagia, allowing to obtain normal growth and adult height. Long term compliance is an important pre-requisite for long term graft function.

Keywords: intestinal transplantation, steatorrhea

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