Clin Nutr ESPEN. 2024 Aug:62:247-252.doi: 10.1016/j.clnesp.2024.05.025. Epub 2024 Jun 3.

F Lacaille ¹, E Ramos Boluda ², G Gupte ³, J Hind ⁴, E Sturm ⁵, J Hilberath ⁵, G Herlenius ⁶, L D'Antiga ⁷, A Pietrobattista ⁸, F Hernandez ², K Sharif ³, H Vilca-Melendez ⁴, S Nadalin ⁵, M Colledan ⁷, C Chardot ⁹

Author information

¹Hôpital Universitaire Necker-Enfants Malades, Paris, France. Electronic address: florence.lacaille@aphp.fr.

²Hospital La Paz, Madrid, Spain.

³Birmingham's Children Hospital, Birmingham, United Kingdom.

⁴King's College Hospital, London, United Kingdom.

⁵Universitätskinderklinik, Tübingen, Germany.

⁶Sahlgrenska University Hospital, Göteborg, Sweden.

⁷Azienda Ospedaliera Papa-Giovanni-23, Bergamo, Italy.

⁸Ospedale Pediatrico Bambino Gesù, Rome, Italy.

⁹Hôpital Universitaire Necker-Enfants Malades, Paris, France.

Abstract

Aims: To report the results and successes of intestinal transplantation (ITx) in the most active European centres, to emphasize that, although it is a difficult procedure, it should remain a therapeutic option for children with total, definitive and complicated intestinal failure when intestinal rehabilitation fails.

Methods: We retrospectively collected data about all patients less than 18 receiving an ITx from 2010 to 2022 in 8 centres, and outcomes in July 2022.

Results: ITx was performed in 155 patients, median age 6.9 years, in 45% for short bowel syndromes, 22% congenital enteropathies, 25% motility disorders, and 15% re-transplantations. Indications were multiple in most patients, intestinal failure-associated liver disease in half. The graft was in 70% liver-containing. At last follow up 64% were alive, weaned from parenteral nutrition, for 7.9 years; 27% had died and the graft was removed in 8%, mostly early after ITx.

Discussion: ITx, despite its difficulties, can give a future to children with complicated intestinal failure. It should be considered among the therapeutic options offered to patients with a predicted survival rate lower than that after ITx. Patients should be early discussed within multidisciplinary teams in ITx centres, to avoid severe complications impacting the results of ITx, or even to avoid ITx.