Fifteen years' experience of intestinal and multivisceral transplantation in the Nordic countries.

OBJECTIVE: Intestinal and multivisceral transplantation have gained acceptance as treatment modalities for patients with: intestinal failure and life-threatening complications of parenteral nutrition (PN), rare cases of vascular abdominal catastrophes and selected cases of low-grade neoplastic tumors such as neuroendocrine pancreatic tumors and desmoids involving the mesenteric root. The aim was to describe the survival and nutritional outcome in the transplanted Nordic patients and the complications attributed to this procedure. METHOD: The authors included all Nordic patients transplanted between January 1998 and December 2013. Information on patients transplanted outside the Nordic region was collected through questionnaires. RESULTS: A total of 34 patients received different types of intestinal allografts. Currently, there are two Nordic transplant centers (n = 29) performing these procedures (Gothenburg, Sweden n = 24, Helsinki, Finland n = 5). The remaining five patients were transplanted in the USA (n = 3) and the UK (n = 2). Most patients were transplanted for life-threatening failure of PN (70%) caused primarily by intestinal motility diseases (59%). Allograft rejection was the most common complication and occurred in 79% of the patients followed by post-transplantation lymphoproliferative disorders (21%) and graft-versus-host disease (18%). The 1- and 5-year survival was 79% and 65% respectively for the whole cohort and nutritional autonomy was achieved in 73% of the adults and 57% of the children at 1 year after transplantation. CONCLUSION: This collective Nordic experience confirms that intestinal transplantation is a complex procedure with many complications, yet with the possibility to provide long-term survival in selected conditions previously considered untreatable.

Management of neutropenic enterocolitis in children with cancer.

AIM: To describe the symptoms, clinical management and short-term outcome in a series of paediatric oncology patients with severe typhlitis following conservative treatment. METHODS: Twelve episodes of severe typhlitis in 11 children with cancer treated at the paediatric oncology ward at Queen Silvias Children's Hospital between 1995 and 2006 were analysed retrospectively. Data on symptoms, radiological findings, laboratory status and treatment as well as outcome were collected and analysed. RESULTS: In all episodes, the classical signs of neutropenia, fever, abdominal pain and thickening of the bowel wall were present. All were successfully treated with bowel rest, broadspectrum antibiotics and supportive care. After recovery from typhlitis, three patients needed surgical intervention because of complications. CONCLUSION: A high clinical suspicion combined with radiological imaging aids early diagnosis. Predisposing factors for developing typhlitis were haematologic malignancy and treatment with chemotherapy within 3 weeks of onset. Supportive care, bowel rest including parenteral nutrition, correction of cytopenias and aggressive antimicrobial treatment is essential. Measurements of C-reactive protein in blood may be of benefit when assessing the clinical course.

Abdominal pathology requiring laparotomy in very preterm infants is associated with need for surgical closure of patent ductus arteriosus.

BACKGROUND: Extensive intestinal surgery in very preterm infants and its influence on somatic growth is of major concern. There is little consensus as to which is the most appropriate surgical approach in extremely low-birth-weight infants with abdominal pathology. Laparotomy is currently advocated, but peritoneal drainage is also discussed. OBJECTIVE: To study laparotomy as surgical intervention in newborn infants with less than 28 gestational weeks and to investigate associated mortality and morbidity and its impact on short-term growth. STUDY DESIGN/METHODS: The study was a retrospective case-control study of newborn infants requiring laparotomy. All infants with gestational age less than 28 weeks who were subject to acute laparotomy in the neonatal period at Sahlgrenska University Hospital during a 5-year period (2003-2007) were included in the study (n = 20). The control group consisted of infants admitted to the unit with the same gestational age but not requiring laparotomy. Infants with severe malformations were excluded. SUMMARY AND CONCLUSION: Extensive abdominal surgery was feasible in very preterm infants. Necrotizing enterocolitis dominated the abdominal pathology requiring surgery. Patent ductus arteriosus requiring surgical closure occurred more often in the lapatotomy group and in those diagnosed as necrotizing enterocolitis. There was no impact on first year somatic growth.