Where are we at with short bowel syndrome and small bowel transplant

Table 1 Causes of intestinal failure in children

Atresia	Necrotizing enterocolitis
Midgut volvulus	Arterial thrombosis
Abdominal wall defects	Venous Thrombosis
Gastrochisis	Intussusception
Ompalocele	Inflamatory bowel disease
Hirschsprung’s disease	Post traumatic resection

Table 2 Indications for bowel transplantation in children and adults

Children	Adults
Gastroschisis	Ischemia
Volvulus	Crohn’s disease
Necrotizing enterocolitis	Trauma
Pseudoobstruction	Volvulus
Intestinal atresia	Motility disorders
Aganglionosis/Hirschsprung	Desmoids
Retransplant	Retransplant
Microvillous inclusion	Miscellaneous
Malabsorption	Gardner’s syndrome
Tumors

Table 3 Contraindications to small bowel transplant

Absolute contraindications

Neurological disabilities

Life threatening disease unrelated to the digestive system

Non-resectable malignancy

Relative contraindications

Severe immunological deficiencies

Multi-system autoimmune diseases

Inadequate vascular anatomy to warrant long term patency

Prematurity with lung disease

Table 4 Histological characteristics of acute rejection of intestinal graft

Mild	> 6 apoptotic bodies/10 crypts, no mucosal ulceration, mild epithelial injury
Moderate	Diffuse crypt epithelial injury, focal confluent apoptosis, intimal arteritis
Severe	Mucosal ulceration, transmural arteritis