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Postoperative Care of the Intestinal Recipient: Graft Monitoring, Nutrition, and Management of Medical Complications

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Solid Organ Transplantation in Infants and Children

Part of the book series: Organ and Tissue Transplantation ((OTT))

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Abstract

Significant improvements have been made in early outcomes following pediatric intestinal transplantation (ITx), yet long-term survival remains challenged by infection and rejection, both of which can present with diarrhea. While stool studies and endoscopy remain the gold standard for graft monitoring, less-invasive, timely, and accurate biomarkers are essential to help improve results. The use of calprotectin, citrulline, donor-specific antibodies, and other novel biomarkers is reviewed in this chapter. Nutrition following ITx is challenged by oral aversion, increased energy needs, malabsorption, and limited catch-up growth. Long-term growth and weight gain post-ITx can be predicted by hospitalizations, rejection, infection, and immunosuppression requirements. Deficiencies in micronutrients, including iron, zinc, and copper, as well as vitamins are commonplace post-ITx and require routine screening. Notable complications following ITx result from the high immunosuppression needs of these children and include tissue invasive CMV (7% prevalence), PTLD (15–20%), infectious enteritis (39–76%), and renal insufficiency (16%).

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Author information

Authors and Affiliations

  1. David Geffen School of Medicine, Los Angeles, CA, USA

    Robert S. Venick & Elaine Y Cheng

Authors
  1. Robert S. Venick
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  2. Elaine Y Cheng
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Corresponding author

Correspondence to Robert S. Venick .

Editor information

Editors and Affiliations

  1. Jefferson Medical College, AI Dupont Hospital for Children Department of Surgery, Wilmington, Delaware, USA

    Stephen P. Dunn

  2. Liver & Intestine Transplantation, Seattle Children’s Hospital Liver & Intestine Transplantation, Seattle, Washington, USA

    Simon Horslen

Section Editor information

  1. Hillman Center for Pediatric Transplantation, Children’s Hospital of Pittsburgh of UPMC, 4401 Penn Avenue (FP, Room 6137), 15224, Pittsburgh, PA, USA

    George Mazariegos

  2. Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA

    Dale Zecca

  3. Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA

    Jennifer Melvin

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Venick, R.S., Cheng, E.Y. (2017). Postoperative Care of the Intestinal Recipient: Graft Monitoring, Nutrition, and Management of Medical Complications. In: Dunn, S., Horslen, S. (eds) Solid Organ Transplantation in Infants and Children. Organ and Tissue Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-319-08049-9_24-1

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  • DOI: https://doi.org/10.1007/978-3-319-08049-9_24-1

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-08049-9

  • Online ISBN: 978-3-319-08049-9

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