JPGN Journal Club July 2024: Intestinal Rehabilitation in Congenital Diarrhea and Biomarker-Based Prognosis After Pediatric Liver Transplantation

JPGN Journal Club reporting for duty, sah! And mem! Here’s the spoken word about the written word . . . in a glorious June, with Heaven and Earth well and true in tune, as the poem goes.  Don’t forget to check out what ESPGHAN has on offer from July onward, available at https://www.espghan.org/knowledge-center ! Dr Jake Mann has chosen for today’s discussion two heavy-hitting publications.  The first, from J Pediatr Gastroenterol Nutr, by Cohen et al., addresses the value of intestinal-rehabilitation treatment in congenital diarrhoea; the second, from J Hepatol, by Chichelnitskiy, Goldschmidt, et al., demonstrates that as the twig (of the biliary tree) is bent, so the hepatic forest is inclined:  That is, a seven-centre study found that prognosis for transplanted livers can be assessed by biomarker profiling in recipient plasma during the allograft’s first year.   Both studies point the way toward the possibility of better clinical care.  A certain biomarker profile signalled longer-term success; can modulation of immunotherapy, or even choice of donor, shift a patient with a less advantageous profile toward an improved outcome, and can the shift be tracked using biomarker-value determinations?  Investigators worldwide are even now rummaging through their freezers, one imagines, for the banked samples to be used in confirming and extending these exciting results.   Toronto, Cincinnati, and Haifa joined forces to assemble the cohorts of children whose longer-term courses they report.  Children with congenital diarrhoea, fifteen in all, did worse overall than did the “control” short-bowel syndrome (SBS) patients (1 : 3) with whom they were compared (59% vs. 87% and 39% vs. 80%, respectively, for 5- and 10-year survival rates).  However, they fared better than did historical congenital-diarrhoea controls, and in some respects they did as well as SBS patients.  Yes, we are making progress, it seems, regardless of how ward rounds leave us feeling from time to time.   Literature Cohen IS et al.  Improved long-term outcome of children with congenital diarrhea followed by an intestinal rehabilitation program.  J Pediatr Gastroenterol Nutr 2024 Jun 3.  Online ahead of print.  Doi: 10.1002/jpn3.12275.  PMID:  38828718. Chichelnitskiy E / Goldschmidt I et al.  Plasma immune signatures can predict rejection-free survival in the first year after pediatric liver transplantation.  J Hepatol 2024 May 29.  Online ahead of print.  Doi: 10.1016/j.jhep.2024.05.032.  PMID:  38821361.