BACKGROUND: Despite improvements in small bowel transplantation (SBTx), early referral of patients with irreversible intestinal failure (IF) remains a major obstacle. In this study we evaluated the demand for SBTx among seven surgical pediatric centers located at least 200 km from our center. METHODS: From 1997 to 2001, 640 patients have been treated for neonatal diseases, including 248 who underwent a minor or major intestinal resection. Twenty-four patients with major resections presented with short gut syndrome, requiring total parenteral nutrition (TPN). The greatest demand was in postsurgical neonates with necrotizing enterocolitis, gastroschiesis, onphalocoeles, or midgut volvulus, and in three adults with postradiotherapy arteritis (n = 2) and mesenteric vein thromboses (n = 1). The median length of residual bowel after resection was 20 to 30 cm, without an ileocecal valve. Four patients were referred for SBTx evaluation; three died while awaiting a donor; 20 were not referred, among whom 14 died of TPN complications. RESULTS: Approximately 62 children per year require nutritional support for IF, most of whom develop complications related to TPN. Because many patients who are TPN-dependent develop complications, we believe that early referral would reduce mortality. CONCLUSIONS: Greater medical awareness about the feasibility of SBTx procedures and earlier referral may improve results and quality of life after transplant.
BACKGROUND: Despite improvements in small bowel transplantation (SBTx), early referral of patients with irreversible intestinal failure (IF) remains a major obstacle. In this study we evaluated the demand for SBTx among seven surgical pediatric centers located at least 200 km from our center. METHODS: From 1997 to 2001, 640 patients have been treated for neonatal diseases, including 248 who underwent a minor or major intestinal resection. Twenty-four patients with major resections presented with short gut syndrome, requiring total parenteral nutrition (TPN). The greatest demand was in postsurgical neonates with necrotizing enterocolitis, gastroschiesis, onphalocoeles, or midgut volvulus, and in three adults with postradiotherapy arteritis (n = 2) and mesenteric vein thromboses (n = 1). The median length of residual bowel after resection was 20 to 30 cm, without an ileocecal valve. Four patients were referred for SBTx evaluation; three died while awaiting a donor; 20 were not referred, among whom 14 died of TPN complications. RESULTS: Approximately 62 children per year require nutritional support for IF, most of whom develop complications related to TPN. Because many patients who are TPN-dependent develop complications, we believe that early referral would reduce mortality. CONCLUSIONS: Greater medical awareness about the feasibility of SBTx procedures and earlier referral may improve results and quality of life after transplant.
Authors: Jason S Hawksworth; Chirag S Desai; Khalid M Khan; Stuart S Kaufman; Nada Yazigi; Raffaele Girlanda; Alexander Kroemer; Thomas M Fishbein; Cal S Matsumoto Journal: Am J Transplant Date: 2018-04-06 Impact factor: 8.086
Authors: Sérgio Paiva Meira Filho; Bianca Della Guardia; Andréia Silva Evangelista; Celso Eduardo Lourenço Matielo; Douglas Bastos Neves; Fernando Luis Pandullo; Guilherme Eduardo Gonçalves Felga; Jefferson André da Silva Alves; Lilian Amorim Curvelo; Luiz Gustavo Guedes Diaz; Marcela Balbo Rusi; Marcelo de Melo Viveiros; Marcio Dias de Almeida; Marina Gabrielle Epstein; Pamella Tung Pedroso; Paolo Salvalaggio; Roberto Ferreira Meirelles Júnior; Rodrigo Andrey Rocco; Samira Scalso de Almeida; Marcelo Bruno de Rezende Journal: Einstein (Sao Paulo) Date: 2015 Jan-Mar
Authors: Wellington Andraus; Rafael Soares Pinheiro; Allana Christina Fortunato; Flavio Henrique Ferreira Galvão; Rubens Macedo Arantes Junior; Daniel Reis Waisberg; Andre Dong Lee; Mariana Hollanda Martins da Rocha; Lucas Souto Nacif; Vinicius Rocha Santos; Liliana Ducatti; Rodrigo Bronze de Martino; Luciana Bertocco de Paiva Haddad; Ryan Yukimatsu Tanigawa; Regis O F Bezerra; Alice Tung Wan Song; Luiz Augusto Carneiro-D'Albuquerque Journal: Clinics (Sao Paulo) Date: 2021-10-29 Impact factor: 2.365