# The current state of paediatric intestinal transplantation: A global review

## TL;DR

Pediatric intestinal transplantation has become a life-saving treatment for children with severe intestinal failure, though challenges and global disparities remain.

## Contribution

This paper provides a global review of the current state and future directions of pediatric intestinal transplantation.

## Key findings

- Advances in surgical techniques and immunosuppression have improved survival and outcomes in pediatric intestinal transplantation.
- Global disparities in access to pediatric ITx persist due to donor scarcity and financial constraints.
- Multidisciplinary care and international collaboration are essential for improving long-term quality of life and equitable access.

## Abstract

Paediatric intestinal transplantation (ITx) has evolved from a high-risk experimental procedure into a life-saving therapy for children who have complications of intestinal failure (IF) or who cannot be stabilized by nutritional rehabilitation. Indications include complications of irreversible intestinal failure from short bowel syndrome, motility disorders, or intestinal dysplasia, with graft options ranging from isolated intestine to liver-intestine or multivisceral transplantation, including reduced-size and living donor grafts. Advances in surgical techniques, perioperative care, and immunosuppression have markedly improved survival and functional outcomes, although early and late graft loss, rejection, and infectious complications remain important challenges. Optimized immunosuppression protocols have reduced acute rejection rates, but also facilitated successful retransplantation when required. Multidisciplinary management addressing growth, neurodevelopment, and psychosocial well-being is recognized as being essential for improving long-term quality of life. Despite these advances, significant global disparities persist in access to paediatric ITx, driven by donor scarcity, financial constraints, and limited expertise in low-resource regions. Collaborative networks, telemedicine platforms, and international registries have emerged to share knowledge, standardize care, and support capacity-building. Looking forward, advancements in immunosuppression, expanded living donor programmes and international collaboration hold promise for further improving outcomes and broadening access. Increasing recognition of the benefits of earlier referral and transplantation is shifting the paradigm from viewing ITx solely as a rescue therapy toward proactive management to optimize survival, growth, and quality of life. Collectively, these developments indicate a future in which paediatric ITx offers not only life-saving treatment but also enhanced long-term health, improved quality of life, and equitable access for children worldwide.