Intestinal/multivisceral transplantation

Gwenn E McLaughlin, Tomoaki Kato

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Intestinal/multivisceral transplantation has evolved from an experimental procedure to the treatment of choice for patients with irreversible intestinal failure and serious complications related to long-term parenteral nutrition. Children who are likely to suffer permanent intestinal failure and benefit from intestinal transplantation include those with a remaining small bowel length of less than 30-40 cm, absence of the ileocecal valve, colonic resection and malabsorptive syndromes. Indications for transplant include frequent severe bouts of catheter associated sepsis, threatened loss of vascular access and the development of liver cirrhosis from cholestasis. Children who are more likely to experience cholestasis from total parenteral nutrition include those who experience persistent hyperbilirubinemia (greater than 6 mg/dl despite enteral nutrition), those with recurrent sepsis and/or bacterial overgrowth and those with minimal tolerance of any enteral feeds in the first few months post resection. The 1 year survival rate after intestinal transplantation has markedly improved over the last several years but long term survival rates have remained unchanged. The improved short term survival rates have led to an increased prevalence of this patient population in intensive care units. Management of intestinal and multivisceral transplant recipients is uniquely challenging because of complications arising from the high incidence of transplant rejection and its treatment. In the ICU, the complexity of medical care for the transplant recipient requires a multidisciplinary approach with coordination by an intensivist in collaboration with the transplant surgeon, gastroenterologist, and other specialists.

Original languageEnglish (US)
Title of host publicationPediatric Critical Care Medicine: Volume 4: Peri-Operative Care of the Critically Ill or Injured Child
PublisherSpringer-Verlag London Ltd
Pages425-441
Number of pages17
ISBN (Print)9781447163596, 9781447163589
DOIs
StatePublished - Jan 1 2014

Keywords

  • Acute cellular rejection
  • Antibody mediated rejection
  • Calcineurin inhibitors
  • Chronic rejection
  • Gastroschisis
  • Graft vs. host disease
  • Herpes virus infections
  • Multivisceral transplantation
  • Necrotizing enterocolitis
  • Post-transplant lymphoproliferative disorder
  • Posterior reversible encephalopathy
  • Reactivation
  • Rituximab
  • Tacrolimus
  • Thymoglobulin
  • Viral infection

ASJC Scopus subject areas

  • Medicine(all)

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  • Cite this

    McLaughlin, G. E., & Kato, T. (2014). Intestinal/multivisceral transplantation. In Pediatric Critical Care Medicine: Volume 4: Peri-Operative Care of the Critically Ill or Injured Child (pp. 425-441). Springer-Verlag London Ltd. https://doi.org/10.1007/978-1-4471-6359-6_30