Pediatric intestine transplant cost: Analysis of the Pediatric Health Information System database

Article Pediatrics

Child self-reported quality of life in pediatric intestinal failure

Melissa Wong et al.

Summary: This study focuses on the self-reported health-related quality of life (HRQOL) in children with intestinal failure (IF), finding that they report better HRQOL compared to parent-proxy data, but still lower than healthy and chronically ill peers. Longer remnant bowel length is associated with decreased HRQOL scores in children.

JOURNAL OF PEDIATRIC SURGERY (2022)

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Article Surgery

OPTN/SRTR 2020 Annual Data Report: Intestine

S. P. Horslen et al.

Summary: Despite small increases in additions to the intestine transplant waitlist, overall intestine transplant activity has decreased over the last decade. Waitlist mortality has continued to fall for pediatric populations and remain stable for adults. While 1-year graft survival has improved, there is no noticeable improvement in 3- and 5-year graft survival. Immunosuppression practices favor the use of an induction agent followed by tacrolimus-based regimens. Patient survival at 5 years is currently the same for isolated intestines and liver-inclusive allograft recipients.

AMERICAN JOURNAL OF TRANSPLANTATION (2022)

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Review Pediatrics

Immunosuppression Regimens for Intestinal Transplantation in Children

Vikram Kalathur Raghu et al.

Summary: Pediatric intestinal transplant is the only definitive treatment for irreversible intestinal failure in children, and its success relies on appropriate management of immunosuppression. The indications for transplant have changed over time, and immunosuppression regimens consist of induction and maintenance phases as well as treatment for acute rejection. Current induction protocols often include antithymocyte globulin or basiliximab in addition to corticosteroids. Maintenance regimens are primarily dominated by tacrolimus, with additional agents used to adjust tacrolimus levels or as adjunct therapy for sensitized patients. Close monitoring is crucial to limit serious complications such as rejection, infection, and malignancy. Future research aims to standardize practice and find optimal immunosuppression methods for individual patients, as well as develop non-invasive monitoring and functional assessments of immunosuppression for intestinal grafts.

PEDIATRIC DRUGS (2022)

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Article Immunology

Cost-effectiveness of Intestinal Transplantation Compared to Parenteral Nutrition in Adults

Emilio Canovai et al.

Summary: Intestinal transplantation (ITx) is initially costly but becomes cost-effective compared to home parenteral nutrition (HPN) in chronic intestinal failure patients by year 4, and cost-saving by year 5.

TRANSPLANTATION (2021)

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Article Nutrition & Dietetics

Cost-effectiveness of teduglutide in pediatric patients with short bowel syndrome: Markov modeling using traditional cost-effectiveness criteria

Vikram Kalathur Raghu et al.

Summary: Using teduglutide in conjunction with offering intestinal transplantation for pediatric patients with short bowel syndrome is not cost-effective at its current price, as it significantly increases the overall cost of treatment. Providing intestinal transplantation without using teduglutide may be a more economically favorable strategy, as shown in probabilistic sensitivity analysis.

AMERICAN JOURNAL OF CLINICAL NUTRITION (2021)

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Article Gastroenterology & Hepatology

Caregiver Decision-making in Pediatric Intestinal Failure: A Qualitative Study Focused on Iron Deficiency Anemia

Vikram Kalathur Raghu et al.

Summary: The study found that caregivers of children with IF prioritize seeking reliable, accurate, and positive information during the decision-making process, and value the role of caregivers on the medical team and the relationships between caregivers and the medical team. Regarding anemia treatment, the key themes included identifying anemia by bloodwork, proactive supplementation, individualized regimens, and prioritizing safety and convenience.

JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION (2021)

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Article Pediatrics