APSA PaperIsolated liver and multivisceral transplantation for total parenteral nutrition–related end-stage liver disease
Section snippets
Methods
We performed a retrospective analysis of patients with ESLD-TPN who underwent either ILT or MVT (liver-small bowel-pancreas allograft or liver-small bowel-pancreas-colon allograft) from 1994 to 2005 at Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. Patients with ESLD-TPN who underwent transplantation were identified by review of the transplant database. Data extracted from medical records included demographics, etiology of intestinal failure, pretransplant small bowel length
Pretransplant status
We identified 12 children with end-stage liver disease secondary to TPN-induced cholestasis who underwent either ILT or MVT from 1994 to 2005 at our institution (Table 1). The median age at transplantation in this cohort was 10.0 months. Seven patients with intestinal failure and ESLD-TPN underwent ILT at a median age of 8.4 months. All 7 patients had jaundice, ascites, and hepatosplenomegaly on physical examination. All had portal hypertension, and 4 patients had recurrent gastrointestinal
Discussion
Patients with intestinal failure who develop manifestations of end-stage liver disease because of the use of long-term TPN represent one of the most challenging clinical problems in pediatric surgery. Most often, intestinal failure is the result of a significant loss of gastrointestinal tract length because of an intraabdominal catastrophe. Before the development of TPN, afflicted infants died. With the successful advent of intravenous nutrition, these children have been given an opportunity
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Indications for Multivisceral Transplantation: A Systematic Review
2024, Gastroenterology Clinics of North AmericaReporting on outcome measures in pediatric chronic intestinal failure: A systematic review
2020, Clinical NutritionInterstitial cells of Cajal are decreased in patients with gastroschisis associated intestinal dysmotility
2015, Journal of Pediatric SurgeryCitation Excerpt :However, even patients who have attained enteral autonomy over time sometimes sustain irreversible liver disease and may require liver transplantation for survival. GAID remains one of the leading causes of intestinal failure associated liver disease (IFALD) [36]. We have previously reported the wide variation in management strategies for GAID between different European centers [37].
Unusual Indications for Transplantation
2015, Transplantation of the Liver: Third EditionLiver Transplant for Cholestatic Liver Diseases
2013, Clinics in Liver DiseaseCitation Excerpt :Sequential small bowel transplant after isolated LT has also been proposed for patients who fail intestinal adaptation post-LT,53 and this approach requires careful assessment to exclude underlying gastrointestinal motility disorders and structural abnormalities, which may impair intestinal adaptation post-LT.53 Although there are no large studies available, disease-specific mortality rates of 43% and 40% have been reported among recipients of isolated LT or multivisceral transplant, respectively.51 Patient and graft survival rates for intestinal transplant and multivisceral transplant were 65% and 60%, respectively, at the end of 1 year, and the overall survival rate was 57% at the end of 2 years.51,54
Intestinal and multivisceral retransplantation results: Literature review
2013, Transplantation Proceedings
Presented at the 37th Annual Meeting of the American Pediatric Surgical Association, May 20–24, 2006, Hilton Head, SC.