Pseudo-obstruction in children: transplant or wait?
- Liver Unit
- Birmingham Children’s Hospital
- Steelhouse Lane
- Birmingham B4 6NH, UK
See article on page 570
With advances in immunosuppression intestinal transplantation has emerged as a viable option for patients with chronic intestinal failure and life threatening complications. With a one year graft survival rate of around 60% over the past few years, the current situation compares favourably with the pre-1990 results when 30% survival rates were achieved (data from the Intestinal Transplant Registry: www.lhsc.on.ca/itr). At the 7th Meeting of the European Intestinal Transplantation Study Group (Brussels, 1998), one year survival rates up to 80–90% were reported by some very experienced centres.
In children, chronic intestinal pseudo-obstruction is often a primary disorder, either congenital or acquired. Secondary pseudo-obstruction is related to various systemic diseases and is more common in older patients. According to the pathological findings, the primary disease is classified as neuropathic, myopathic, or idiopathic if no specific pattern is recognised. The disease always involves the small bowel and may occur in any other (or all) regions of the digestive tract. …