Five Year Experience of a joint multidisciplinary intestinal Failure Assessment and small Bowel Transplantation Centre – the Great Ormond Street/King’s College Hospital Model

Nandhini Kumaraguru¹, Jonathan Hind², Nigel Heaton², Hector Vilaca-Melendez², Susan Hill¹, Jutta Koeglmeier¹

¹Great Ormond Street Hospital , Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom; ²King's College Hospital, London, United Kingdom

Background

In the last two decades the incidence of  intestinal failure (IF) has constantly increased  due to improved survival of extreme prematurity and raising incidence of gastroschisis [1]. Improved management of structural, inflammatory and motility disorders has led to the need for long term parenteral nutrition (PN) in a larger number of children. At present around 150 British children are managed on home PN.

A new multidisciplinary intestinal failure assessment (IFA) and small bowel transplantation (SBT) centre was hence nationally commissioned in the United Kingdom. Clinical services started in April 2008. Patients are referred to Great Ormond Street Hospital for assessment of their intestinal function and sent to King’s College Hospital if criteria for SBT are fulfilled.

Aim

To report the experience of a new intestinal rehabilitation centre since the beginning of the program in 2008.

Methods

Retrospective case note review of all patients referred for IFA and SBT.

Results

A total of 46 children were referred for IFA of which 24/46 underwent assessment for potential SBT.  8/46 successfully weaned off PN with improved clinical management. 12/46 did not fulfill the criteria for SBT and remain on PN. 2/46 families declined the SBT offer. 10/46 underwent SBT. 1 child died post SBT due to severe graft rejection. 9/10 transplanted children are alive and well. No patient died on the waiting list.

Conclusion

Improved medical management by a highly specialized centre can prevent the need for small bowel transplantation in a significant number of patients.

Short term survival post SBT in this new centre is promising with 90 % of patients being alive and well following surgery.