Small bowel transplantation, long considered a rescue therapy for patients with intestinal failure, is now a well recognised alternative treatment strategy to parental nutrition (PN).
Dr Lacaille and colleagues from France conducted a retrospective study, graft functions in 31 children after small bowel transplantation with a follow-up of 2 to 18 years.
|Enteral nutrition was required for 45% at 2 years post-transplantation|
The team found 12 children had isolated small bowel transplantation, 19 had combined liver-small bowel transplantation, and 17 received an additional colon graft.
Growth, nutritional markers, stool balance studies, endoscopy and graft histology were recorded every 2 to 3 years post-transplantation.
The researchers found that all children were weaned from parental nutrition after transplantation, and 26 children remained parental nutrition -free.
Enteral nutrition was required for 45% of patients at 2 years post-transplantation.
The team found all children had high dietary energy intakes.
The degree of steatorrhea was fairly constant, with fat and energy absorption rates of 84% to 89%.
Growth parameters revealed at transplantation a mean height Z-score of -1.17.
The team found after transplantation, that 75% of children had normal growth.
In 33% of children, Z-scores remained lower than -2, concomitant to a delayed puberty.
Adult height was normal in 83%.
The team found endoscopy and histology analyses were normal in asymptomatic patients.
Chronic rejection occurred only in non-compliant patients.
The researchers reported that 5 intestinal grafts were removed 3 to 8 years post-transplantation for acute or chronic rejection.
Dr Lacaille's team concluded, "This series indicates that long-term intestinal autonomy for up to 18 years is possible in the majority of patients after small bowel transplantation."
"Subnormal energy absorption and moderate steatorrhoea were often compensated for by hyperphagia, allowing normal growth and attainment of adult height."
"Long-term compliance is an important pre-requisite for long-term graft function."