Children (May 2022)

Bridging Liver Transplantation in the Treatment of Intestinal Failure Associated Liver Disease in Infants—A Bridge Too Far?

  • Abubakar Sharif,
  • Khalid Sharif,
  • Darius F. Mirza,
  • Girish L. Gupte

DOI
https://doi.org/10.3390/children9050699
Journal volume & issue
Vol. 9, no. 5
p. 699

Abstract

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Infants with intestinal failure associated liver disease (IFALD) requiring liver and bowel transplant have a high mortality on the transplant waiting list due to the scarcity of the size-matched donor organs. Bridging liver transplantation has been used to allow the children to grow to a reasonable size so that a combined liver and small bowel transplant could be performed in the future. We report on two children with irreversible intestinal failure (ultra-short bowel syndrome secondary to gastroschisis and microvillous inclusion disease) with IFALD who underwent bridging liver transplantation at our institution. Both patients made a good recovery from their initial surgery. One patient died 6 months following surgery from generalized sepsis, and the other patient survived in good condition to undergo a combined liver and small bowel transplant but died a few days post-transplant. In the current era of scarcity of donor organs, this raises an ethical dilemma for the team involved regarding appropriate utilisation of a scarce resource.

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