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The current status of intestinal transplantation

Fryer, Jonathan P

Current Opinion in Organ Transplantation: June 2008 - Volume 13 - Issue 3 - p 266–272
doi: 10.1097/MOT.0b013e3282fd6901
Small bowel transplantation: Edited by Gonzalo P. Rodriguez-Laiz
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Purpose of review The aim of this article is to assess the current status of intestinal transplantation.

Recent findings Long-term parenteral nutrition, while often life-sustaining, can be associated with life-threatening complications including parenteral nutrition-associated liver disease. Intestine transplant was developed to rescue patients that are at high risk of these complications. Most patients, however, are not considered for an intestinal transplant until they develop severe parenteral nutrition-associated liver disease and require a liver transplant also. Candidates referred this late have inferior outcomes both on the waiting list and after transplant compared with patients referred earlier needing only and intestine transplant. Rejection remains a difficult problem after intestinal transplantation, but infectious complications continue to be the major cause of morbidity and mortality. Outcomes with intestinal transplantation are steadily improving and 1-year patient survival for intestine only transplants is similar to liver transplants. Intestinal transplantation should be considered earlier in patients at high risk for developing parenteral nutrition-associated liver disease and other life-threatening complications. Better risk-stratification criteria are needed to identify these patients in a timely manner.

Summary The role of intestinal transplantation in the overall management of intestinal failure continues to evolve as its outcomes progressively improve and the risk factors for parenteral nutrition therapy failure become better defined.

Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA

Correspondence to Jonathan P. Fryer, MD, Suite 17-200, 675 North St. Clair Street, Chicago, IL 60611-2923S, USA Tel: +1 312 695 2125; fax: +1 312 695 9194; e-mail: jfryer@nmh.org

© 2008 Lippincott Williams & Wilkins, Inc.