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

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.

Automated summary

Infants with intestinal failure associated liver disease (IFALD) often face high mortality on the transplant waiting list due to the scarcity of size-matched donor organs. Bridging liver transplantation has been used to address this issue, and we report on two cases where children with irreversible intestinal failure underwent this procedure. While both patients initially recovered well, one died from sepsis after 6 months and the other died a few days post-transplant. This raises ethical concerns about the appropriate utilization of scarce donor resources in the current era of organ scarcity.