Increased Ostomy Output and Fevers in a Child with Small Bowel Transplant

Rejection of a transplanted small bowel is clinically ambiguous and lacks a reliable biomarker. If clinical suspicion is high, patients should be aggressively treated with appropriate IV antibiotics and fluids and transferred to a transplant center. Sepsis is the leading cause of mortality in these children (Martinez Rivera A, Wales PW, Pediatr Surg Int. 2016;32:529–40; Amrita Narang et al. Transplant Proc. 2019;51:3181–5), and they often need broader coverage with antimicrobials given their limited antibiotic sensitivity and poor enteral absorption.