Intestinal transplant program

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The pediatric intestinal rehabilitation and transplantation program at Children's Memorial is one of few such programs in the nation dedicated entirely to the care of children. Our multidisciplinary team of surgeons, gastroenterologists, nurse practitioners, and nutritionists is committed to avoiding transplant if possible by using medical, surgical and nutritional rehabilitation strategies to reduce or eliminate total parenteral nutrition (TPN) dependence. Each child that comes to us with intestinal failure will be thoroughly evaluated by our team to determine the most effective treatment plan.

The program is led by Dr. Valeria Cohran, who is recognized as a leader in the emerging field of intestinal rehabilitation. Under Dr. Cohran's leadership, referrals to our program have steadily increased, with 26 new patients enrolled in the program last year alone. The program receives referrals not just from the neonatal intensive care unit (NICU) at Children's Memorial Hospital but from other institutions across the state. Dr. Cohran and the advance practice nurses are members of the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) and have participated in and given lectures at A.S.P.E.N.'s annual conference.

Some highlights of our program include:

Since the program's inception in 2003, approximately 80% of patients enrolled in our intestinal rehabilitation program have avoided transplantation through intestinal rehabilitation.
More than 85% of our currently active patients have been successfully rehabilitated and are off TPN.
The program uses surgical techniques to increase length or volume of the patient's intestine in an effort to increase the quality and functionality of the patient's own bowels in an effort to improve the patient's nutrition, growth, development and motility.

Background on intestinal failure and treatment

The leading causes of intestinal failure — more commonly referred to as short bowel syndrome (SBS) — in the pediatric population are necrotizing enterocolitis and gastroschisis.
Our team of physicians and surgeons uses novel approaches to avoid transplant when possible to help these patients maintain growth and nutrition. The serial transverse enteroplasty (STEP) procedure is a surgical technique used to increase bowel length to help absorption in the intestine so it can function more efficiently.
The team also uses nutritional strategies to help patients maintain normal growth in spite of their intestinal failure. Often TPN is needed to help maintain growth, which can sometimes cause additional problems, including liver disease. If the medical, surgical, and nutritional strategies fail, the team pursues the possibility of isolated intestinal transplant before irreversible TPN-associated liver injury mandates inclusion of a liver transplant as well.