The new Intestinal Transplantation and Rehabilitation Program at
Children's Memorial Hospital was launched in 2004 with Kishore Iyer, MD, as
director. One of the first multidisciplinary intestinal failure and
transplantation programs dedicated entirely to the care of children, the program
involves nutritionists, gastroenterologists, hepatologists, and surgeons with
expertise in autologous gut salvage and intestinal transplantation. The
Children's Memorial program is affiliated with Northwestern University's
Feinberg School of Medicine Intestinal Rehabilitation Program.
Irrespective of the cause of intestinal failure, following initial
resuscitation and care of the patient from intestinal catastrophe, the team's
goal is to stabilize the patient on total parenteral nutrition (TPN), which can
then be safely continued at home. Stable patients are later carefully weaned off
TPN, starting with simple dietary and medical manipulations, and progressing as
needed to non-transplant surgical strategies. Intestinal transplantation is used
only with a limited subset of patients who fail all conservative attempts and
are at risk of death from worsening complications of TPN.
Iyer's team has been highly successful in avoiding the need for intestinal
transplantation in many patients with intestinal failure through application of
innovative medical and surgical strategies, such as Bianchi intestinal
lengthening procedure. The team's initial experience with this procedure
suggests that even patients with advanced liver disease, including cirrhosis and
portal hypertension due to TPN, can achieve full recovery of the liver and even
come off TPN in some cases.
Through his ongoing research into TPN-associated liver
disease - which today remains the predominant indication for combined liver and
small bowel transplantation - Iyer hopes to eventually prevent TPN-associated
liver disease and significantly reduce the need for complex transplant
procedures.