Isolated Liver Transplant in Infants With Short Bowel Syndrome: Insights Into Outcomes and Prognostic Factors

• DOI: 10.1097/mpg.0b013e31818c6099
• Publication Date: 2009-05-21T13:29:05Z
• Authors: D Dell‐Olio; SV Beath; J de Ville de Goyet; S Clarke; P Davies; C Lloyd; S Protheroe; AJW Millar; DA Kelly; GL Gupte
• Keywords: Short Bowel Syndrome; Enteral administration; Liver disease; Intestinal Failure; Medical record

Selected infants with short bowel syndrome (SBS) and progressive intestinal failure associated liver disease (IFALD) may benefit from isolated transplantation (iLTx). The aim of the study is to identify risk factors for unfavourable outcome in iLTx.A retrospective review medical records 1998 2005 was undertaken. Risk were assessed by comparing long-term survivors those who died after iLTx.Fifteen iLTx performed 14 IFALD. All parenteral nutrition (PN) dependent, but had tolerated enterally 54% (38-100) energy intake before iLTx. Median residual 60 cm (30-200). Eight out intact ileocaecal valve (ICV). bilirubin 298 micromol/L (87-715) all portal hypertension. 9 weaned PN median 15 months. In 4 children, nontransplant surgery facilitated adaptation. Growth velocity improved at 3 years (P=0.001). Five children poor enteral tolerance following (P<0.002), which correlated pretransplant dysmotility seen 5 shown contrast studies (P=0.02)and increased frequency line infections (>6/year P<0.04) (P<0.001) iLTx.Isolated a lifesaving option selected SBS Revised criteria are proposed: IFALD; 50 functional absence ICV or 30 ICV; 50% daily weeks satisfactory growth; dysmotile should be combined liver/bowel transplant unless resolved minimal infections.