Pediatric intestinal transplant: Perioperative complications and management

Abstract

Intestinal transplantation offers a life-saving option for children with irreversible intestinal failure and complications of prolonged parenteral nutrition. Advances in surgical techniques, perioperative care, and immunosuppressive strategies have improved outcomes, though the procedure remains complex. Pretransplant evaluation requires multidisciplinary assessment of candidacy, nutritional status, vascular access, and psychosocial support. Counselling prepares families for stoma care, nutritional rehabilitation, and potential complications. Immunosuppression typically involves induction with interleukin-2 receptor antagonists or anti-thymocyte globulin, followed by tacrolimus-based maintenance. Postoperative care focuses on vigilant monitoring for surgical complications, graft rejection, and infection. Common issues include abdominal compartment syndrome, bowel leaks, obstruction, and high stoma losses. Rejection is frequent, necessitating endoscopic and histologic confirmation, with treatment tailored to severity. Opportunistic infections, graft-versus-host disease, and rare immune-mediated hemolytic anemia require early recognition and multidisciplinary intervention. Life long follow up ensures graft survival, optimum nutrition and improvement in quality of life.