Long-term results of intestinal transplantation in children: survival after 10 years, intestinal function, quality of life.

Abstract

The review aims to describe in detail contemporary medical, nutritional, and psychosocial results in pediatric intestinal transplant (ITx) recipients greater than 10 years removed from their transplant, and to highlight significant long-term post-ITx challenges and complications. The review will draw from recent publications in the field, the ITx registry as well as detailed unpublished data from a large, well established single center. The majority of long-term ITx survivors are off parenteral nutrition altogether, but a significant number require supplemental tube feeds to gain weight and grow properly. A number of micronutrient deficiencies are observed in long-term follow-up. Renal insufficiency and posttransplant lymphoproliferative disorder are the most concerning long-term complications. Many require special education, and in certain domains some report lower health related quality of life. For children more than 10 years out from ITx, growth and weight gain are sustained; oral aversion and dependence on supplemental tube feeds remain prevalent issues. Most recipients are successfully managed with frequent outpatient visits and multiple daily medications. Post-transplant lymphoproliferative disorder and chronic kidney disease are long-term concerns. Though many children require special education, most are high functioning and report good health-related quality of life.