Once a child is diagnosed with intestinal disease it is important to make a thorough assessment to determine the severity of the intestinal disease and its projected outcome. Decisions for management of these patients are made by a multidisciplinary team to examine all options of therapy and intervention. Symptoms and findings that may indicate the need for an intestine transplant are:
- Failure of synthetic function (decrease albumin, elevated clotting times, etc.)
- Portal hypertension with bleeding (variceal bleeding)
- Severe hypersplenism along with liver dysfunction (decreased platelet count)
- Unacceptable quality of life (itching, poor growth, failure to thrive)
- Recurrent cholangitis
- Malnutrition
- Encephalopathy (elevated ammonia levels in the blood)
- Progressive jaundice
Through its success, intestinal transplantation is now an option for patients with a life-threatening intestinal disease.
Selection Criteria for Intestinal Transplant Recipients
Based upon the practice of different small bowel transplant centers and the International Intestinal Transplant Registry, the following criteria are recommended:
- Early referral without limitation of weight or age is recommended for any child who is likely to eventually require intestinal transplant.
- Development of liver dysfunction due to total parenteral nutrition (TPN) inducted cholestatis
- Loss of venous access
- Frequent life-threatening line sepsis
- Frequent episodes of severe dehydration in spite of TPN and fluid supplementation
- Significant limitation in quality of life due to TPN restrictions on daily activities
- Premalignant (extensive polyposis) or locally aggressive (desmoid) small bowel tumors
The following may be either relative or absolute contraindications at this time:
- Significant, uncorrectable cardiopulmonary insufficiency
- Incurable malignancy
- Persistent systemic infections
- Severe systemic autoimmune disease
Learn more about What Intestinal Diseases Lead to Transplantation.
