Intestinal transplantation in children: Preliminary experience in Paris

Olivier Goulet, Dominique Jan, Florence Lacaille, Virginie Colomb, Jean Luc Michel, Diane Damotte, Philippe Jouvet, Nicole Brousse, Christophe Faure, Jean Pierre Cézard, Sabine Sarnacki, Michel Peuchmaur, Philippe Hubert, Claude Ricour, Yann Révillon

Research output: Contribution to journalArticle

40 Scopus citations

Abstract

From November 1994 to November 1998, 20 children (2.5 to 14 years) received a jejunoileal graft alone (SBTx; n = 10) or in combination with the liver (SBLTx; n = 10 and/or the right colon (5 SBTx). Indications were intractable diarrhea of infancy (n = 8), short bowel syndrome (n = 6), extensive Hirschsprung disease (n = 4), and chronic intestinal pseudoobstruction (n = 2). Immunosuppression included tacrolimus, methylprednisolone, and azathioprine. Current follow-up ranges from 6 to 54 months. Five patients died (3 SBTx) within the first 2 months. Acute liver rejection occurred in 5 patients during the first 2 months. Sixteen episodes of intestinal rejection during the first 3 months in 11 patients (8 in 4 SBTx) were successfully treated in all but 3 by increasing tacrolimus dose and/or a 3-day methyprednisolone bolus or required antilymphoglobulins in 3 cases. Surgical complications occurred 8 times after SBLTx and 3 after SBTx. Infectious complications were more frequent in SBLTx recipients. Reversible Epstein-Barr virus-related posttransplant lymphoproliferative disease occurred in 3 recipients. Five presented cytomegalovirus infection. The SB graft was removed in 5 recipients (3 chronic rejection). All patients were started with oral and/or enteral feeding from the 7th postoperative day by using either normal food or protein hydrolysate diet. Currently, 10 of 11 children (8 SBLTx) achieved digestive autonomy after 5 to 30 weeks. All recipients gained weight; however, growth velocity remained reduced during the first 6 months because of the steroid therapy. Overall graft and patient survival is higher after SBLTx. Intestinal transplantation is indicated for patients with permanent intestinal failure. However, because parenteral nutrition is generally well tolerated, even for long periods, each indication for transplantation must be weighed carefully in terms of risk and quality of life.

Original languageEnglish (US)
Pages (from-to)S121-S125
JournalJournal of Parenteral and Enteral Nutrition
Volume23
Issue number5_suppl
DOIs
StatePublished - Sep 1 1999
Externally publishedYes

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

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    Goulet, O., Jan, D., Lacaille, F., Colomb, V., Michel, J. L., Damotte, D., Jouvet, P., Brousse, N., Faure, C., Cézard, J. P., Sarnacki, S., Peuchmaur, M., Hubert, P., Ricour, C., & Révillon, Y. (1999). Intestinal transplantation in children: Preliminary experience in Paris. Journal of Parenteral and Enteral Nutrition, 23(5_suppl), S121-S125. https://doi.org/10.1177/014860719902300530