# Intestinal Transplant — GCMD Library living collection

Also covered as: intestinal failure · necrotizing enterocolitis · bladder outlet obstruction · posterior urethral valves · oligohydramnios · inguinal hernia · umbilical hernia · wound dehiscence

Experts: Dr. Dr. Alonzo, Dr. Todd Ponsky, Dr. Ian Glenn, Dr. Brad Warner

Updated: n/a · 4 episodes · 113 cited statements

## Episodes
### Surgical Management
- [Renal transplantation: Cincinnati Fetal Center](https://qa.library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623) — video · 13:51 · [machine version](https://qa.library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623.md)
- [Renal transplantation: Fetal Genitourinary Disease 2015](https://qa.library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915) — video · 13:44 · [machine version](https://qa.library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915.md)

### Evidence & Research
- [Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308) — podcast · 44:19 · [machine version](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308.md)

### In-Depth Reviews
- [Intestinal Failure with Dr. Brad Warner](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296) — podcast · 52:46 · [machine version](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296.md)

## Chapters
- [0:00](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=0) Introduction and Episode Overview (Ep 3)
- [1:39](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=99) Definition and Prognostic Factors in Intestinal Failure (Ep 3)
- [5:29](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=329) Natural History and Outcomes in Short Gut Syndrome (Ep 3)
- [10:22](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=622) Medical Management and TPN Strategy (Ep 3)
- [17:51](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1071) Enteral Feeding Strategy and Intestinal Adaptation (Ep 3)
- [21:48](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1308) Indications for Surgical Intervention (Ep 3)
- [26:01](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1561) Surgical Techniques: Bianchi and STEP Procedures (Ep 3)
- [36:00](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2160) Bowel Tapering and Technical Considerations (Ep 3)
- [41:31](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2491) Management of TPN-Related Cholestasis and Bacterial Overgrowth (Ep 3)
- [43:35](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2615) Growth Factors and Future Therapies (Ep 3)
- [46:31](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2791) Intestinal Transplantation: Indications and Outcomes (Ep 3)
- [51:21](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=3081) Multidisciplinary Care and Closing Remarks (Ep 3)
- [0:00](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=0) Introduction and series overview (Ep 4)
- [0:55](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=55) Corticosteroids after Kasai for biliary atresia (Dr. von Almen) (Ep 4)
- [10:54](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=654) Skin antiseptic agents and surgical site infections (Dr. Holcomb, part 1) (Ep 4)
- [20:18](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1218) Non-operative antibiotic treatment for non-perforated appendicitis (Dr. Holcomb, part 2) (Ep 4)
- [30:41](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1841) Predictors of enteral autonomy in pediatric intestinal failure (Dr. Lipskar, part 1) (Ep 4)
- [36:44](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2204) Anesthetic neurotoxicity in the developing brain (Dr. Lipskar, part 2) (Ep 4)
- [0:00](https://qa.library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=0) Early surgical interventions: gastrostomy tubes and peritoneal dialysis catheters (Ep 1)
- [3:35](https://qa.library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=215) Timing and approach for renal transplantation in infants (Ep 1)
- [5:45](https://qa.library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=345) Technical discussion: gastrostomy tube placement considerations (Ep 1)
- [11:50](https://qa.library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=710) Anatomical observations: small stomach phenomenon in bladder outlet obstruction (Ep 1)
- [0:00](https://qa.library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=0) Early surgical interventions: G-tube and PD catheter placement (Ep 2)
- [3:28](https://qa.library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=208) Infant renal transplantation technique and complications (Ep 2)
- [6:40](https://qa.library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=400) G-tube placement strategy and anatomic considerations (Ep 2)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "The START trial randomized 140 infants with biliary atresia to high-dose steroids (IV for 2 weeks, oral for 2 weeks, taper over 9 weeks) versus placebo within 72 hours of Kasai portoenterostomy." — Daniel von Allmen (host_summary) [Ep 4 · 2:48](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=168)
- "The primary outcome was serum total bilirubin <1.5 mg/dL with native liver at 6 months post-Kasai; the study was powered to detect a 25% absolute treatment difference." — Daniel von Allmen (host_summary) [Ep 4 · 3:32](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=212)
- "High-dose steroid therapy after Kasai did not result in a statistically significant treatment difference in bile drainage at 6 months: 58.6% in the steroid group versus 48.6% in placebo." — Daniel von Allmen (host_summary) [Ep 4 · 4:01](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=241)
- "Survival without liver transplant at 24 months was not statistically different: 58.7% for steroids versus 49.4% for placebo." — Daniel von Allmen (host_summary) [Ep 4 · 4:39](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=279)
- "Adverse events were common in both groups (near 80%), largely reflecting severe underlying liver dysfunction; steroid treatment was associated with earlier onset of serious adverse events." — Daniel von Allmen (host_summary) [Ep 4 · 4:55](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=295)
- "Dr. von Almen personally used steroids after Kasai in the past but has stopped based on the START trial results." — Daniel von Allmen (opinion) [Ep 4 · 5:31](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=331)
- "The authors of the START trial believe anything less than a 25% difference in bile drainage is not worth the potential early complications of steroids." — Daniel von Allmen (host_summary) [Ep 4 · 7:11](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=431)
- "Two proposed mechanisms for steroid benefit in biliary atresia: reducing ongoing inflammation to preserve ductules, and acting as a choleretic to maintain bile flow (analogous to diuresis after kidney transplant)." — Daniel von Allmen (clinical) [Ep 4 · 9:09](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=549)
- "The START trial specifically tested a 13-week course of high-dose steroids; the lack of benefit applies to that regimen." — Daniel von Allmen (clinical) [Ep 4 · 10:09](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=609)
- "A Washington State registry study of clean-contaminated adult general surgery cases (60% colorectal, 34% bariatric) found no single skin antiseptic agent associated with lower SSI risk than any other." — Whit Holcomb (host_summary) [Ep 4 · 11:20](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=680)
- "Isopropyl alcohol as part of the antiseptic mixture conferred no benefit: unadjusted SSI rate 4.5% without alcohol versus 4.6% with alcohol." — Whit Holcomb (host_summary) [Ep 4 · 13:49](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=829)
- "The registry could not identify SSI diagnosed after discharge, likely underestimating the true SSI rate; a recent report showed 50% or more SSIs are diagnosed after discharge." — Whit Holcomb (host_summary) [Ep 4 · 14:20](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=860)
- "Most SSIs occur 3–10 days after operation; average length of stay in the study was 6–7 days." — Whit Holcomb (host_summary) [Ep 4 · 14:48](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=888)
- "Dr. Holcomb's institution switched to chlorhexidine with isopropyl alcohol (chloraprep) except for mucous membrane preps (e.g., circumcision)." — Whit Holcomb (clinical) [Ep 4 · 16:30](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=990)
- "Most pediatric surgery cases are clean (not clean-contaminated), so the Washington State study does not directly address pediatric practice." — Whit Holcomb (opinion) [Ep 4 · 17:03](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1023)
- "Chloraprep or similar agents dry faster than betadine/iodine preps, allowing cases to start sooner; this matters when doing 6–7 cases per day." — Whit Holcomb (clinical) [Ep 4 · 18:16](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1096)
- "A pilot randomized trial in children aged 5–15 with non-perforated appendicitis (based on imaging) compared non-operative antibiotic treatment versus laparoscopic appendectomy; follow-up was one year." — Whit Holcomb (host_summary) [Ep 4 · 20:35](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1235)
- "Of 225 children with appendicitis, 50 were randomized (26 to surgery, 24 to antibiotics); 77 families declined participation." — Whit Holcomb (host_summary) [Ep 4 · 22:42](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1362)
- "In the antibiotic group, 2 of 24 underwent appendectomy during primary treatment, 1 had recurrent appendicitis at 9 months, and 6 more had appendectomy for recurrent pain or parental desire (none with histologic appendicitis)—total 9 of 24 (38% failure rate)." — Whit Holcomb (host_summary) [Ep 4 · 23:14](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1394)
- "Median time to discharge was significantly shorter in the surgical group, but the antibiotic group had a stipulated 48-hour minimum hospitalization." — Whit Holcomb (host_summary) [Ep 4 · 24:35](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1475)
- "Cost for the initial inpatient stay was significantly lower in the antibiotic group despite longer hospitalization, highlighting the cost of undergoing an operation." — Whit Holcomb (host_summary) [Ep 4 · 24:55](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1495)
- "The pilot study demonstrates that a definitive randomized trial comparing antibiotics and laparoscopic appendectomy for non-perforated appendicitis is safe and feasible; a multi-center study is planned." — Whit Holcomb (host_summary) [Ep 4 · 25:20](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1520)
- "Dr. Holcomb has not treated acute appendicitis non-operatively at his institution but knows of poor operative candidates treated successfully with antibiotics." — Whit Holcomb (opinion) [Ep 4 · 26:33](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1593)
- "Immunosuppressed cancer patients with typhlitis (not appendicitis but similar) are sometimes treated non-operatively, and most resolve with antibiotics." — Whit Holcomb (clinical) [Ep 4 · 27:00](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1620)
- "The challenge will be identifying which population of appendicitis patients can be treated successfully non-operatively versus which should undergo early operation." — Whit Holcomb (opinion) [Ep 4 · 27:22](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1642)
- "Long-term follow-up is critical; even a 10-year follow-up leaves patients only 15–20 years old, with 40–50 years of life remaining at risk for recurrent appendicitis." — Whit Holcomb (opinion) [Ep 4 · 27:52](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1672)
- "Some parents in the pilot study wanted their child's appendix removed to avoid future worry, even after successful antibiotic treatment." — Whit Holcomb (host_summary) [Ep 4 · 29:19](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1759)
- "If appendectomy can be done as an outpatient same-day procedure, it may be difficult to argue for 1–2 days of antibiotics with uncertain long-term recurrence risk." — Whit Holcomb (opinion) [Ep 4 · 29:45](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1785)
- "A PIFCON multi-center cohort study of 272 children with intestinal failure (median follow-up 33 months) found enteral autonomy was achieved in 43%, 13% remained PN-dependent, and 43% died or underwent transplant." — Aaron Lipskar (host_summary) [Ep 4 · 31:31](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1891)
- "Necrotizing enterocolitis as the underlying diagnosis, care at an intestinal rehab facility without a transplant center, and presence of an ileocecal valve were all statistically significantly associated with higher rates of enteral autonomy." — Aaron Lipskar (host_summary) [Ep 4 · 32:58](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1978)
- "Residual small bowel length was also a statistically significant predictor of enteral autonomy, though less impressive than the other three variables." — Aaron Lipskar (host_summary) [Ep 4 · 33:19](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=1999)
- "The protective effect of necrotizing enterocolitis on enteral autonomy is surprising and goes against understanding of that inflammatory illness, showing how much remains to be learned." — Aaron Lipskar (opinion) [Ep 4 · 33:55](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2035)
- "A companion paper in the same journal (Journal of Pediatrics, July 2015) found necrotizing enterocolitis was a poor predictor of growth outcome in infants with short bowel syndrome." — Aaron Lipskar (host_summary) [Ep 4 · 34:46](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2086)
- "The PIFCON study underscores the importance of managing children with intestinal failure in multidisciplinary intestinal rehab programs, where catheter-associated bloodstream infection elimination and cholestasis prevention have changed outcomes." — Aaron Lipskar (opinion) [Ep 4 · 36:11](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2171)
- "Animal studies show that commonly used anesthetics and sedatives (propofol, etomidate, sevoflurane, isoflurane, ketamine) that increase GABA receptor activity or block glutamate receptors produce neurotoxic effects in laboratory animals from nematodes to nonhuman primates." — Aaron Lipskar (host_summary) [Ep 4 · 38:09](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2289)
- "Observational studies in children undergoing early anesthesia offer conflicting results and are confounded by multiple factors, but suggest some children may have deficits—association, not causation." — Aaron Lipskar (host_summary) [Ep 4 · 38:43](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2323)
- "SmartTots June 2014 statement concluded that animal data is sufficiently convincing to warrant large-scale clinical studies and recommended avoiding anesthesia in children under 3 unless urgent or potentially harmful if not attended to." — Aaron Lipskar (host_summary) [Ep 4 · 39:11](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2351)
- "Dr. Lipskar has not yet delayed an inguinal hernia repair for anesthetic concerns." — Aaron Lipskar (opinion) [Ep 4 · 40:53](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2453)
- "At Cohen Children's Medical Center, circumcisions outside the neonatal period are done with general plus regional anesthesia." — Aaron Lipskar (clinical) [Ep 4 · 41:09](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2469)
- "Regional anesthesia and agents like precedex may help decrease the amount of potentially neurotoxic general anesthesia; almost every laparoscopic, thoracoscopic, or open operation has a regional block option." — Aaron Lipskar (opinion) [Ep 4 · 41:31](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2491)
- "Dr. Ponsky's chief of anesthesiology instituted a 'rule of two': defer elective operations until after age 2 and avoid two anesthetics in one year." — Todd Ponsky (clinical) [Ep 4 · 42:16](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2536)
- "Dr. Ponsky now defers dermoid cyst excision in a 6-month-old until 18 months but does not delay inguinal hernia repair due to known incarceration risk in young infants." — Todd Ponsky (opinion) [Ep 4 · 42:31](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2551)
- "A survey of ~150 parents in a primary care pediatrics office found the vast majority did not know anesthetic neurotoxicity was a major issue (Dr. Lipskar's unpublished study, to be presented at AAP)." — Aaron Lipskar (clinical) [Ep 4 · 43:17](https://qa.library.globalcastmd.com/watch/biliary-atresia-appendicitis-intestinal-failure-and-anesthetic-308?t=2597)
- "Infants with renal failure are often called for gastrostomy tube and peritoneal dialysis catheter placement within the first few days of life." — Alonso (clinical) [Ep 1 · 0:13](https://qa.library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=13)
- "Babies that make urine are not likely to need peritoneal dialysis immediately but are likely to need it in the future." — Alonso (clinical) [Ep 1 · 0:31](https://qa.library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=31)
- "Peritoneal dialysis catheters should ideally be left alone for a couple of weeks after placement if possible." — Alonso (clinical) [Ep 1 · 0:49](https://qa.library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=49)
- "Gastrostomy tube placement is focused along the lesser curvature or close to it to preserve stomach tissue for potential future bladder augmentation by Doctor Reddy." — Alonso (clinical) [Ep 1 · 0:49](https://qa.library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=49)
- "Gastrostomy tube placement is performed laparoscopic-assisted to visualize exact stomach location, then the camera is turned into the pelvis to position the PD catheter." — Alonso (clinical) [Ep 1 · 1:21](https://qa.library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=81)
- "The nephrology team is generally good at predicting which babies will need a peritoneal dialysis catheter." — Alonso (opinion) [Ep 1 · 1:42](https://qa.library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=102)
- "Hemodialysis catheters need to be fairly large caliber and are preferentially placed in the right internal jugular site because it provides a straight shot into the atrium." — Alonso (clinical) [Ep 1 · 2:04](https://qa.library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=124)
- "Inguinal and umbilical hernias can develop when babies are on peritoneal dialysis." — Alonso (clinical) [Ep 1 · 3:03](https://qa.library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=183)
- "Hernias in dialysis patients are generally left alone if they are not affecting dialysis mechanics or causing symptoms." — Alonso (clinical) [Ep 1 · 3:03](https://qa.library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=183)
- "The ideal weight for infant renal transplantation is around 10 kg if the patient is not on peritoneal dialysis." — Alonso (clinical) [Ep 1 · 3:46](https://qa.library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=226)
- "Infants on peritoneal dialysis have a more accommodating abdominal cavity and laxity in the abdominal wall, allowing transplantation at weights closer to 8 kg." — Alonso (clinical) [Ep 1 · 4:08](https://qa.library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=248)
- "All infant renal transplant recipients at this center have been transplanted with adult donor kidneys." — Alonso (clinical) [Ep 1 · 4:24](https://qa.library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=264)
- "An extraperitoneal approach is used for infant renal transplantation with an incision extending to the upper edge close to the costal margin." — Alonso (clinical) [Ep 1 · 4:39](https://qa.library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=279)
- "Wound complications are the biggest complication from a general surgical perspective in infant renal transplantation, surprisingly more common than vascular complications." — Alonso (clinical) [Ep 1 · 5:06](https://qa.library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=306)
- "Some infant transplant patients can only be closed at the skin level initially and develop leaks or dehiscence requiring biologic mesh (such as derma matrix) for closure." — Alonso (clinical) [Ep 1 · 5:15](https://qa.library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=315)
- "In a 13-year follow-up study of gastrostomy tubes in babies, all G-tubes migrated superiorly onto the chest wall." (clinical) [Ep 1 · 7:21](https://qa.library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=441)
- "Placing gastrostomy tubes too close to peritoneal dialysis catheters creates infection risk early on because drainage can get underneath the PD catheter dressing when there is insufficient space between sites." — Alonso (clinical) [Ep 1 · 7:54](https://qa.library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=474)
- "The standard gastrostomy tube insertion site is 2 finger breadths below the costal margin." — Alonso (clinical) [Ep 1 · 8:31](https://qa.library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=511)
- "For patients with posterior urethral valves, gastrostomy tube location is placed high on the stomach toward the lesser curvature to preserve the ability to use a gastric segment for gastric augmentation later in life." (clinical) [Ep 1 · 8:48](https://qa.library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=528)
- "Some infants with posterior urethral valves will need urinary diversion with a vesicostomy placed about 1-2 finger breadths below the umbilicus, requiring mitigation of infection risks by spacing catheter sites appropriately." (clinical) [Ep 1 · 9:13](https://qa.library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=553)
- "Peritoneal dialysis catheters can be placed in a way that allows immediate use with lower volumes, though waiting for healing is preferable." — Alonso (clinical) [Ep 1 · 11:27](https://qa.library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=687)
- "Many infants with bladder outlet obstruction have unusually small stomachs, potentially related to minimal amniotic fluid during development." (host_summary) [Ep 1 · 11:50](https://qa.library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=710)
- "Amnioinfusions are performed when patients present for first imaging to assess the baby's capacity to swallow and see if the stomach fills." (clinical) [Ep 1 · 12:30](https://qa.library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=750)
- "Early onset large bladders that extend upward and push the diaphragm and stomach back may cause anatomical distortion that results in stomachs ending up higher long-term." (opinion) [Ep 1 · 13:23](https://qa.library.globalcastmd.com/watch/renal-transplantation-cincinnati-fetal-center-623?t=803)
- "Infants who make urine are not likely to need peritoneal dialysis immediately but will likely need it in the future" (clinical) [Ep 2 · 0:25](https://qa.library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=25)
- "When placing both G-tube and PD catheter together, the PD catheter should be left alone for a couple of weeks if possible" (clinical) [Ep 2 · 0:45](https://qa.library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=45)
- "Gastrostomy tube placement should focus on the lesser curvature to preserve the stomach for potential future bladder augmentation" (clinical) [Ep 2 · 0:54](https://qa.library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=54)
- "Hemodialysis catheters need to be fairly large caliber and placement should stay as much as possible to the right internal jugular site because that is a straight shot into the atrium" (clinical) [Ep 2 · 2:11](https://qa.library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=131)
- "Inguinal and umbilical hernias can develop when babies are on peritoneal dialysis" (clinical) [Ep 2 · 2:56](https://qa.library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=176)
- "If hernias are not affecting the mechanics of dialysis and not particularly symptomatic, they tend to be left alone" (clinical) [Ep 2 · 2:56](https://qa.library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=176)
- "The ideal weight for infant renal transplant is around 10 kg if not on PD" (clinical) [Ep 2 · 4:01](https://qa.library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=241)
- "Infants on PD can be transplanted closer to 8 kg because they have a more accommodating abdominal cavity and laxity in the abdominal wall" (clinical) [Ep 2 · 4:01](https://qa.library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=241)
- "All infant recipients have been transplanted with adult donors" (clinical) [Ep 2 · 4:17](https://qa.library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=257)
- "An extraperitoneal approach is used for infant renal transplantation with an incision extending to the upper edge close to the costal margin" (clinical) [Ep 2 · 4:32](https://qa.library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=272)
- "The biggest complication from a general surgical perspective in infant renal transplants are wound complications as opposed to vascular complications" (clinical) [Ep 2 · 4:59](https://qa.library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=299)
- "Some infants can only have skin closed initially and develop leaks or dehiscence requiring biologic mesh (such as derma matrix) for closure" (clinical) [Ep 2 · 5:08](https://qa.library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=308)
- "In a 13-year follow-up of G-tubes in babies, they all migrate up onto the chest" (clinical) [Ep 2 · 7:14](https://qa.library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=434)
- "Placing G-tube too close to PD catheter creates infection risk early on because there is not enough space between sites and drainage can get underneath the PD catheter dressing" (clinical) [Ep 2 · 7:47](https://qa.library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=467)
- "Standard G-tube insertion site is 2 finger breadths below the costal margin" (clinical) [Ep 2 · 8:24](https://qa.library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=504)
- "In small babies, G-tube should be placed 3 or 4 finger breadths below costal margin because it will rise up with growth" (clinical) [Ep 2 · 8:32](https://qa.library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=512)
- "G-tube location should be high up on the stomach towards lesser curvature to allow ability to use gastric segment for gastric augmentation later in life" (clinical) [Ep 2 · 8:46](https://qa.library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=526)
- "Some babies with posterior urethral valves will need urinary diversion with vesicostomy about 1-2 finger breadths below the umbilicus, requiring G-tube placement away from this site to mitigate infection risk" (clinical) [Ep 2 · 9:06](https://qa.library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=546)
- "PD catheters can be placed to allow immediate use with lower volumes rather than waiting 3-7 days" (clinical) [Ep 2 · 11:20](https://qa.library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=680)
- "Many babies with bladder outlet obstruction have small stomachs, possibly related to minimum amniotic fluid during development" (host_summary) [Ep 2 · 11:43](https://qa.library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=703)
- "Amnioinfusions are performed when patients present for first imaging to assess the baby's capacity to swallow and see if the stomach fills" (clinical) [Ep 2 · 12:23](https://qa.library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=743)
- "In fetal imaging, bladder and bladder wall thickness and isthmus are always measured" (clinical) [Ep 2 · 12:49](https://qa.library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=769)
- "Early onset large bladders that extend up and push the diaphragm and stomach back may cause anatomic distortion that results in stomachs ending up higher long term" (opinion) [Ep 2 · 13:16](https://qa.library.globalcastmd.com/watch/renal-transplantation-fetal-genitourinary-disease-2015-915?t=796)
- "Intestinal failure is an umbrella term for when the small intestine is unable to absorb or digest enough nutrition to support the patient entirely by oral or enteral feeding" — Brad Warner (clinical) [Ep 3 · 1:42](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=102)
- "The intestine of a newborn or fetus doubles in length in the last trimester of gestation" — Brad Warner (clinical) [Ep 3 · 3:03](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=183)
- "A 24-25 week premature infant with 20-25 cm of bowel will likely increase to at least 50 cm just on the basis of growth alone" — Brad Warner (clinical) [Ep 3 · 3:13](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=193)
- "For a neonate with ileocecal valve and entire colon, 10-15 cm of small intestine is a ballpark figure for potential viability" — Brad Warner (clinical) [Ep 3 · 4:03](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=243)
- "Without the colon and ileocecal valve, at least 15-20 cm of small intestine would be needed for potential viability in a neonate" — Brad Warner (clinical) [Ep 3 · 4:37](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=277)
- "In adult studies, patients with less than 50 cm of intestine have about 40% mortality after 5-10 years" — Brad Warner (epidemiological) [Ep 3 · 4:51](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=291)
- "According to Pediatric Intestinal Failure Research Consortium data, of children on TPN for more than several months due to short gut syndrome: 25% die, 25% need transplant, and 50% can wean off TPN" — Brad Warner (epidemiological) [Ep 3 · 6:38](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=398)
- "Common causes of death in intestinal failure include liver failure, septic episodes from central line or bacterial overgrowth, variceal bleeding from liver disease, and loss of IV access" — Brad Warner (clinical) [Ep 3 · 7:11](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=431)
- "Intestinal adaptation in humans probably takes place over about a year or two after small bowel resection" — Brad Warner (clinical) [Ep 3 · 7:49](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=469)
- "The goal of management is to wean TPN and push enteral feeding, accepting stool outputs of up to 40 cc per kilo per day as the limit" — Brad Warner (clinical) [Ep 3 · 8:19](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=499)
- "The most common reasons children develop short gut syndrome are necrotizing enterocolitis, gastroschisis, midgut volvulus, and atresias" — Brad Warner (epidemiological) [Ep 3 · 9:22](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=562)
- "For TPN, target about 100-120 calories per kilo per day for total calories, with about 50% from glucose and remainder from fat and protein" — Brad Warner (clinical) [Ep 3 · 10:22](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=622)
- "Shoot for about 2-3 g of protein per kilo per day and about 2-3 g of fat per kilo per day in TPN" — Brad Warner (clinical) [Ep 3 · 10:45](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=645)
- "Begin enteral feeding as soon as feasible after resection and reanastomosis when they start stooling, generally starting with slow continuous drip" — Brad Warner (clinical) [Ep 3 · 11:06](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=666)
- "With continuous drip feeding, nutrient transporters are upregulated and ability to get more nutrition in may be advantageous" — Brad Warner (opinion) [Ep 3 · 11:23](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=683)
- "Want a baby to gain about 20-30 g a day, which approximates in utero progression for a newborn" — Brad Warner (clinical) [Ep 3 · 12:05](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=725)
- "Lipid reduction strategy takes fat from 2-3 g per kilo per day given daily down to about 1 g per kilo per day delivered twice or 3 times a week, which has been effective in reducing TPN-associated cholestasis" — Brad Warner (clinical) [Ep 3 · 12:53](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=773)
- "Omegaven is a fish oil-based fat containing primarily omega-3 fatty acids that are anti-inflammatory, compared to soybean-based intralipid with omega-6 fatty acids that are pro-inflammatory" — Brad Warner (clinical) [Ep 3 · 14:03](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=843)
- "When fish oil (omegaven) is introduced to children getting jaundiced, there has been demonstrated significant fall in their jaundice levels" — Brad Warner (clinical) [Ep 3 · 14:38](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=878)
- "SMOF lipid contains soybean-based lipid (essential fatty acids), medium chain triglycerides (more easily digested), olive oil, and fish oil, and has recently been FDA approved in the United States" — Brad Warner (clinical) [Ep 3 · 15:08](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=908)
- "Breast milk is the best choice for neonates because it contains proper fat, growth factors like EGF and IGF, and milk oligosaccharides that enhance adaptation" — Brad Warner (opinion) [Ep 3 · 18:11](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1091)
- "Complex formulas fed enterally may stimulate adaptation better than elemental formulas by causing secretion of enterotrophic hormones to a greater extent" — Brad Warner (opinion) [Ep 3 · 19:26](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1166)
- "There is a threshold percentage of enteral calories that prevents onset of liver damage from TPN, with 90% enteral feeding having far less risk of TPN-related cholestasis than 10% enteral" — Brad Warner (clinical) [Ep 3 · 21:19](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1279)
- "Time to consider surgical intervention is when enteral tolerance plateaus and then declines (going backward rather than forward), or with multiple sepsis episodes plus abdominal distention and dilated bowel loops, or when child starts getting jaundiced" — Brad Warner (clinical) [Ep 3 · 22:33](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1353)
- "Dilated bowel loops can cause subclinical portal bacteremia contributing to jaundice, and bacterial overgrowth causes secretory diarrhea that impairs enzyme function" — Brad Warner (clinical) [Ep 3 · 23:28](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1408)
- "More than 4-5 centimeters of bowel dilation with failure to advance enteral feeds or going backward is an indication for surgical intervention" — Brad Warner (clinical) [Ep 3 · 25:43](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1543)
- "If a child has over 100 centimeters of intestine, less than 5-10% should require TPN, suggesting there may be an underlying motility or mucosal problem" — Brad Warner (clinical) [Ep 3 · 27:53](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1673)
- "For bowel lengthening, need less than 100 cm (ideally less than 50 cm) of intestine and bowel that is at least 4-5 cm dilated" — Brad Warner (clinical) [Ep 3 · 28:37](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1717)
- "The STEP (serial transverse enteroplasty) procedure has emerged as the most commonly performed lengthening operation" — Brad Warner (epidemiological) [Ep 3 · 29:31](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1771)
- "The Bianchi procedure takes advantage of the V-shaped blood supply bifurcation before reaching the bowel wall, allowing creation of two tubes each supplied by one arm of the V" — Brad Warner (clinical) [Ep 3 · 30:00](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1800)
- "STEP procedure is easier to perform with less risk of injuring mesenteric blood supply because you only cut partially across the bowel at right angles" — Brad Warner (clinical) [Ep 3 · 32:30](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1950)
- "STEP can redilate requiring redo procedures, and outcomes are not as good if you have to redo a STEP compared to never needing a redo" — Brad Warner (clinical) [Ep 3 · 32:54](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=1974)
- "You can do a Bianchi and then later do a STEP on top of it, but you cannot do a Bianchi once a STEP has been done" — Brad Warner (clinical) [Ep 3 · 33:26](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2006)
- "In a case where a STEP was acting as a brake causing dysmotility, removing the distal stepped bowel allowed the patient to completely wean off TPN" — Brad Warner (clinical) [Ep 3 · 35:04](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2104)
- "Would taper a child with dilated bowel who had at least 90-100 centimeters of intestinal length" — Brad Warner (clinical) [Ep 3 · 38:23](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2303)
- "Strategies for TPN cholestasis include bile salts (chenodeoxycholic acid), changing lipid composition, and increasing enteral feeds" — Brad Warner (clinical) [Ep 3 · 39:00](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2340)
- "Dan Teitelbaum's trial of cholecystokinin to promote bile flow and mitigate TPN cholestasis did not work" — Brad Warner (clinical) [Ep 3 · 39:23](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2363)
- "Dilated bowel is a nidus for infection encouraging translocation of bacteria and endotoxin into portal circulation, damaging the liver" — Brad Warner (clinical) [Ep 3 · 39:51](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2391)
- "Medical management of bacterial overgrowth includes oral antibiotics (Cipro, Flagyl), probiotics (lactobacilli), prebiotics, and potentially fecal transplantation" — Brad Warner (clinical) [Ep 3 · 40:26](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2426)
- "The gut bacteria in short gut syndrome become more efficient, creating an obesogenic-like microbiome that helps adapt by encouraging greater absorption and digestion" — Brad Warner (clinical) [Ep 3 · 41:54](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2514)
- "In mouse studies, oral vancomycin to knock out gram-positive organisms completely prevented hepatic steatosis after bowel resection" — Brad Warner (clinical) [Ep 3 · 42:19](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2539)
- "Teduglutide (GLP-2 analog) has been shown in randomized prospective trials in adults to reduce TPN requirements by about 1-2 liters per week" — Brad Warner (clinical) [Ep 3 · 43:57](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2637)
- "Teduglutide is not yet approved for children in the United States, with concerns about malignancy risk due to promoting proliferation" — Brad Warner (clinical) [Ep 3 · 44:34](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2674)
- "Growth factors shown to promote adaptation in animal studies include EGF, HB-EGF (demonstrated by Gail Bessner), interleukins, and growth hormone with glutamine" — Brad Warner (clinical) [Ep 3 · 45:13](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2713)
- "Growth hormone and glutamine combinations in patients have shown primarily mixed results and are expensive" — Brad Warner (clinical) [Ep 3 · 45:46](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2746)
- "Survival for small bowel transplant is about 50-60% at 5 years, with one-year survivals now above 70-80%" — Brad Warner (epidemiological) [Ep 3 · 46:51](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2811)
- "The intestine is highly immunogenic, filled with white cells and macrophages that mount a huge graft-versus-host response, requiring industrial strength immunosuppression" — Brad Warner (clinical) [Ep 3 · 47:11](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2831)
- "Ethanol locks for central lines have significantly reduced the number of sepsis episodes in patients with short gut syndrome who have Broviac catheters" — Brad Warner (clinical) [Ep 3 · 49:22](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=2962)
- "Multidisciplinary teams including pharmacists, nutritionists, surgeons, GI doctors, ID specialists, and interventional radiologists improve survival in intestinal failure patients, as demonstrated in series from Boston, Michigan, and Texas" — Brad Warner (clinical) [Ep 3 · 51:20](https://qa.library.globalcastmd.com/watch/intestinal-failure-with-dr-brad-warner-296?t=3080)

## Changelog
- Sep 9: Summaries and takeaways published for 4 audiences
- Aug 31: 7 doctors auto-found from episode dossiers
- Aug 30: 7 doctors auto-found from episode dossiers
- Aug 30: 7 doctors auto-found from episode dossiers
- Aug 29: 7 doctors auto-found from episode dossiers
- Aug 29: 7 doctors auto-found from episode dossiers
- Aug 29: Collection generated from campaign corpus: 4 items, 4 dossiers, summaries for 4 audience(s)
- Aug 29: Collection reviewed and published
- Aug 29: Collection generated from campaign corpus: 4 items, 4 dossiers, summaries for 4 audience(s)

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