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Treatment of intestinal failure: intestinal transplantation

Nature Clinical Practice Gastroenterology & Hepatology volume 4, pages 503–510 (2007)Cite this article

Abstract

Over the past 15 years, intestinal transplantation for the treatment of intestinal failure has changed from a desperate last-ditch effort into a standard therapy for which a good outcome is expected. Patient survival after intestinal transplantation has improved in the past 3–5 years and now approaches that of other solid organ allograft recipients, including liver and kidney, and is similar to survival on permanent therapy with parenteral nutrition. Complications are more common and often more severe during the initial hospitalization period after intestinal transplantation than they are after transplantation of other solid organs. After intestinal transplantation the initial hospitalization period is, therefore, usually 3–8 weeks long. Nearly all patients discharged after intestinal transplantation have good allograft function and have been weaned from total parenteral nutrition. The cost of the initial hospitalization period is one to two times the cost of permanent total parenteral nutrition for 1 year, which means that, in most cases, intestinal transplantation is cost-saving within 2 years of transplantation. In addition, quality of life after intestinal transplantation, as determined by standardized quality of life measures, is good or normal.

Key Points

  • More than 30,000 patients in the US have intestinal failure that needs to be supported by total parenteral nutrition (TPN)

  • At least 4–10% of patients who are permanently dependent on TPN develop life-threatening complications, such as severe line sepsis, loss of venous access or parenteral nutrition associated cholestasis

  • Patient and graft survival after intestinal transplantation has improved markedly over the past 5 years and now approximate survival after isolated liver transplantation in high-volume centers of excellence

  • Newer immunosuppressive regimens have substantially decreased the rates of acute rejection of the intestinal allograft

  • The risks to living donors do not seem to be justified in most instances of living related small bowel transplantation, and the results are equivalent or inferior to intestinal transplantation using cadaveric donor allografts

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Figure 1: Survival of intestinal failure patients remaining on TPN compared with small bowel transplantation

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Author notes

  1. University Medical Associates, 983285 Nebraska Medical Center, Omaha, NE 68198, USA dsudan@unmc.edu

Authors and Affiliations

  1. DL Sudan is a Professor of Surgery, Director of the Intestinal Rehabilitation Program and Director of Living Donor Liver Transplantation at the University of Nebraska Medical Center, Omaha, NE, USA.,

    Debra L Sudan

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Sudan, D. Treatment of intestinal failure: intestinal transplantation. Nat Rev Gastroenterol Hepatol 4, 503–510 (2007). https://doi.org/10.1038/ncpgasthep0901

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