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Organ Transplantation

Small Bowel Transplantation

Small bowel transplantation is an important treatment option for intestinal dysfunction or short bowel syndrome in which children do not have enough small bowel to absorb nutrients.

Care for small bowel syndrome involves the integration of expertise by pediatric gastroenterologists, pediatric transplant surgeons, and pediatric surgeons. The condition generally appears within a few weeks of birth, brought on by a congenital disorder or an early onset inflammatory bowel condition. Prognosis can often be predicted by the location and length of the bowel, and intestinal rehabilitation should be considered in patients capable of absorbing oral nutrients. Transplantation remains reserved for patients with irreversible intestinal problems associated with life-threatening complications.

Approximately 20 percent of patients with small bowel syndrome are candidates for small bowel transplantation, and 80 percent are generally candidates for rehabilitation. Patients may need to receive supplemental nutrition through a central intravenous line-total parenteral nutrition (TPN)-a form of nutrition delivered into a vein for patients unable to absorb nutrients through the intestinal tract. If this proves unsuccessful or has complications, small bowel transplantation may be recommended.

In some patients, taking an aggressive nutritional approach via TPN will restore bowel health and avoid transplantation-the goal of intestinal rehabilitation.

Our experience with small bowel transplant spans two decades, including surgery on a four-month old girl, who today, at 18, is the longest survivor of a small bowel transplant in the world.

Specialized Expertise

In addition to treating short bowel syndrome, the expertise of our gastroenterologists and transplant specialists include the following conditions:

  • Gastroschisis
  • Ileal atresia
  • Intestinal atresia
  • Intestinal pseudo-obstruction
  • Jejunal atresia
  • Malabsorption
  • Necrotizing enterocolitis (NEC)
  • Short bowel syndrome (SBS)
  • Volvulus
STEP - Serial Transverse Enteroplasty Procedure

It is important to make sure that patients are as nutritionally sound as possible before transplantation to prevent post-transplant complications, including sepsis, clotting, liver problems, the development of an abdominal fistula (a wound that does not heal), an ostomy, or a nasogastric (NG) tube.

When indicated, our surgeons provide pre-transplant surgical management involving longitudinal intestinal lengthening-a bowel-lengthening procedure, called serial transverse enteroplasty or STEP-that is performed prior to transplant with promising surgical and nutritional outcomes. This procedure enables food to move more quickly through the repaired bowel and nutrients to be more quickly absorbed. At NewYork-Presbyterian Morgan Stanley Children's Hospital, the procedure is performed by a team of pediatric gastroenterologists, pediatric surgeons, and pediatric transplant surgeons to ensure the best outcomes.

Isolated Small Bowel or Multiorgan Transplantation

Our pediatric transplant surgeons can perform small bowel transplantation for specific sections of the colon, such as the large bowel. We also can combine liver and small bowel transplantation, as well as liver, small bowel, and colon transplantation if necessary. For some patients, our surgeons rebuild the colon to avoid any permanent colostomy. They can also perform a multi-visceral transplantation-the transplantation of more than four organs: stomach, small bowel, pancreas, liver, and large bowel.

Bianchi Procedure

The Bianchi procedure, in which the bowel is cut in half and one end is sewn to the other, is used to treat short bowel syndrome when the intestine is stretched beyond its normal dimensions (symmetric bowel dilatation).

Post-Surgical Rehabilitation

Following surgery, patients are referred to a pediatric rehabilitation center for after care to further the recovery process prior to going home. The Hospital's social workers meet with our transplant team frequently to develop the most appropriate discharge plan and address any concerns families may have.

Research

Ongoing research continues to explore therapeutic interventions to optimize adequate digestion and absorption of nutrients. Our physicians are pursuing clinical research related to treatment of liver complications-particularly cholestasis jaundice-as the result of TPN management.

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