Indications for pediatric intestinal transplantation: A position paper of the American Society of Transplantation
Indications for pediatric intestinal transplantation: A position paper of the American Society of Transplantation
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DOI：
10.1034/j.1399-3046.2001.005002080.x
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发表时间：
2001-04-01
影响因子：
1.3
通讯作者：
Tzakis, AG
中科院分区：
文献类型：
--
作者：
Kaufman, SS;Atkinson, JB;Tzakis, AG
肠外营养是患有短肠综合征和其他原因的肠道衰竭的儿童的标准治疗方法。大多数患有短肠综合征的婴儿最终会脱离肠外营养，而大多数未断奶的婴儿会长期耐受肠外营养。然而，仍有依赖肠外营养的肠衰竭儿童的一部分会因治疗而出现威胁移位的并发症。现在可以建议该特定群体进行肠移植（Ts）。需要考虑肠道 Tx 的危及生命的并发症包括肠外营养相关的肝病、复发性脓毒症和中心静脉通路威胁丧失。由于供体器官严重短缺，肠道 Tx 的等待时间延长。因此，必须尽早发现患有肠衰竭和肠外营养治疗危及生命并发症的儿童，即在病情危重之前及时接受合适的供体器官。患有肝功能障碍的儿童在出现不可逆的晚期桥接纤维化或肝硬化之前，应考虑进行孤立性肠道 Tx 治疗。为此需要进行肝脏和肠道联合移植。高胆红素血症持续超过 3-4 个月，并伴有门静脉高压症的特征，如脾肿大、血小板减少或突出的腹浅静脉，提示不可逆性肝病；食管静脉曲张、腹水和合成功能受损并不总是存在。在等待肝肠联合移植期间，因肝衰竭并发症导致的死亡尤其常见，肝肠联合移植后的生存率可能低于孤立肠移植后的存活率。肠道 Tx 后的发病率和死亡率为： 高于肝脏或肾脏 Tx 后的发病率和死亡率，但肠道 Tx 后的长期生存率目前至少为 50-60%。随着手术技术和术后管理（包括免疫抑制）的不断改进，未来的结果可能会有所改善。
Parenteral nutrition represents standard therapy for children with short bowel syndrome and other causes of intestinal failure. Most infants with short bowel syndrome eventually wean from parenteral nutrition, and most of those Those do not wean tolerate parenteral nutrition for protracted periods. However, a subset of children with intestinal failure remaining dependent on parenteral nutrition will develop lift-threatening complications arising from therapy. Intestinal transplantation (Ts) can now be recommended for this select group. Life-threatening complications warranting consideration of intestinal Tx include parental nutrition-associated liver disease, recurrent sepsis, and threatened loss of central venous access. Because a critical shortage of donor organs exists, waiting times for intestinal Tx are prolonged. Therefore, it is essential that children with life-threatening complications of intestinal failure and parental al nutrition therapy be identified comparatively early, i.e. in time to receive suitable donor organs before they become critically ill. Children with liver dysfunction should be considered for isolated intestinal Tx before in-eversible, advanced bridging fibrosis or cirrhosis supervenes. for which a combined liver and intestinal transplant is necessary. Irreversible liver disease is suggested by hyper bilirubinemia persisting beyond 3-4 months of age combined with features of portal hypertension such as splenomegaly, thrombocytopenia, or prominent superficial abdominal veins; esophageal varices, ascites, and impaired synthetic function are not always present. Death resulting from complications of liver failure is especially common during the wait for a combined liver and intestinal transplant, and survival following combined liver and intestinal Tx is probably lower than following an isolated intestinal transplant. The incidence of morbidity and mortality following intestinal Tx is: greater than that following liver or kidney Tx, but long-term survival following intestinal Tx is now at least 50-60%. It is probable that outcomes shall improve in the future with continued refinements in operative technique and post-operative management, including immunosuppression.