Pediatric Small Bowel Transplantation

Purpose of Review: Small bowel transplantation is the only currently available option for children with permanent intestinal failure that can allow for full enteral nutrition. The aim of this article is to provide a comprehensive review of the indications, surgical technique, allograft types, perioperative management, and outcomes of children who undergo intestinal transplantation. Recent Findings: Advancements in the management of immunosuppression and associated complications have been the most recent contributor to improved patient outcomes following intestinal transplantation. Most centers have adopted protocols that consist of maintenance therapy with tacrolimus following induction with a steroid bolus and either an IL-2 antagonist, rabbit antithymocyte globulin, or alemtuzumab. Some will eventually convert patients from tacrolimus to sirolimus for long-term maintenance. Improved viral detection methods have allowed for early detection and management of EBV-associated complications including PTLD. Novel methods for early and less invasive detection of acute cellular rejection may allow for decreased morbidity from this complication in the future. Summary: While outcomes following intestinal transplantation have improved, they lag behind those for other solid organ transplants due to the high rate of immunologic complications found in this patient population. Future progress will depend on development of methods for earlier and more accurate detection of rejection, improvements in the detection and management of infection-related complications including PTLD, and on refinements in the management of chronic rejection.