Small intestinal transplantation for irreversible intestinal failure in children.

Permanent intestinal failure, whether secondary to severe gastrointestinal tract dysfunction or short bowel syndrome, remains a challenging pediatric health problem that requires innovative therapeutic modalities. Steatorrhea and intractable diarrhea result in failure to thrive, hypovitaminosis, hypoproteinemia, electrolyte disturbance, and metabolic acidosis if parenteral alimentation (TPN) is begun too late. A variety of medical and surgical treatments have been devised to address each of the underlying causes of childhood intestinal failure. Nonetheless, a significant percentage of children with intestinal failure remain permanently bound to parenteral nutrition. While some of these children suffer minimal morbidity, others succumb to the life-threatening complications of TPN. Until recently they had no hope for survival, but within the past decade small intestinal transplantation has offered them an opportunity for prolonged life emancipated from the shackles of TPN. In this review, we shall discuss in detail microvillus inclusion disease. intestinal pseudoobstruction. and short bowel syndrome. which are the most common causes of pediatric intestinal failure coming to intestinal transplantation. The factors facilitating intestinal adaptation or predisposing to irreversible liver disease in children with short bowel syndrome will be described. We shall also enumerate the indications