The gap in referral criteria for pediatric intestinal transplantation

Background: Advancement in treatment of children with intestinal failure did not lead to change in generally accepted referral criteria for intestinal transplantation. Therefore, a study was conducted to evaluate the current referral criteria and to identify potential new criteria for pediatric intestinal transplantation among transplant centers in Europe, the United States, and Canada. Methods: The literature was searched to identify discussion points regarding current referral criteria and potential needs for extension. Questionnaires were sent to 50 centers performing pediatric intestinal transplantation. Close-ended questions were analyzed with descriptive statistics. Open-ended questions were analyzed by two reviewers using the thematic analysis method. Data were analyzed with SPSS version 17. Results: A total of 18 questionnaires were completed (response rate, 36%; 14 centers in Europe and 4 centers in the United States and Canada). Of all the respondents, 77% considered referral of children as too late and suggested that education of referring hospitals could improve this. Of all the respondents, 50% considered the current referral criteria as too general. More specifically, respondents suggested that "persistent hyperbilirubinemia" must be defined by a time-and-value limit and that the list of referral criteria should include recurring septic episodes and fluid/electrolyte disturbances. Conclusions: Referral criteria for pediatric intestinal transplantation can be improved by defining more specified decision moments and by educating referring hospitals.

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