The Gap in Referral Criteria for Pediatric Intestinal Transplantation

Abstract

Advancement in treatment of children with intestinal failure did not lead to change in generally accepted referral criteria for intestinal transplantation. Therefore, a study was conducted to evaluate the current referral criteria and to identify potential new criteria for pediatric intestinal transplantation among transplant centers in Europe, the United States, and Canada. The literature was searched to identify discussion points regarding current referral criteria and potential needs for extension. Questionnaires were sent to 50 centers performing pediatric intestinal transplantation. Close-ended questions were analyzed with descriptive statistics. Open-ended questions were analyzed by two reviewers using the thematic analysis method. Data were analyzed with SPSS version 17. A total of 18 questionnaires were completed (response rate, 36%; 14 centers in Europe and 4 centers in the United States and Canada). Of all the respondents, 77% considered referral of children as too late and suggested that education of referring hospitals could improve this. Of all the respondents, 50% considered the current referral criteria as too general. More specifically, respondents suggested that "persistent hyperbilirubinemia" must be defined by a time-and-value limit and that the list of referral criteria should include recurring septic episodes and fluid/electrolyte disturbances. Referral criteria for pediatric intestinal transplantation can be improved by defining more specified decision moments and by educating referring hospitals.