Intestine Transplant Indicators in Children

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:

  1. Early referral without limitation of weight or age is recommended for any child who is likely to eventually require intestinal transplant.
  2. Development of liver dysfunction due to total parenteral nutrition (TPN) inducted cholestatis
  3. Loss of venous access
  4. Frequent life-threatening line sepsis
  5. Frequent episodes of severe dehydration in spite of TPN and fluid supplementation
  6. Significant limitation in quality of life due to TPN restrictions on daily activities
  7. Premalignant (extensive polyposis) or locally aggressive (desmoid) small bowel tumors

The following may be either relative or absolute contraindications at this time:

  1. Significant, uncorrectable cardiopulmonary insufficiency
  2. Incurable malignancy
  3. Persistent systemic infections
  4. Severe systemic autoimmune disease

Learn more about What Intestinal Diseases Lead to Transplantation.