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2017 ; 5
(1
): 20-28
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Current status of intestinal and multivisceral transplantation
#MMPMID28130374
Bharadwaj S
; Tandon P
; Gohel TD
; Brown J
; Steiger E
; Kirby DF
; Khanna A
; Abu-Elmagd K
Gastroenterol Rep (Oxf)
2017[Feb]; 5
(1
): 20-28
PMID28130374
show ga
Clinical-nutritional autonomy is the ultimate goal of patients with intestinal
failure (IF). Traditionally, patients with IF have been relegated to lifelong
parenteral nutrition (PN) once surgical and medical rehabilitation attempts at
intestinal adaptation have failed. Over the past two decades, however, outcome
improvements in intestinal transplantation have added another dimension to the
therapeutic armamentarium in the field of gut rehabilitation. This has become
possible through relentless efforts in the standardization of surgical
techniques, advancements in immunosuppressive therapies and induction protocols
and improvement in postoperative patient care. Four types of intestinal
transplants include isolated small bowel transplant, liver-small bowel
transplant, multivisceral transplant and modified multivisceral transplant.
Current guidelines restrict intestinal transplantation to patients who have had
significant complications from PN including liver failure and repeated
infections. From an experimental stage to the currently established therapeutic
modality for patients with advanced IF, outcome improvements have also been
possible due to the introduction of tacrolimus in the early 1990s. Studies have
shown that intestinal transplant is cost-effective within 1-3 years of graft
survival compared with PN. Improved survival and quality of life as well as
resumption of an oral diet should enable intestinal transplantation to be an
important option for patients with IF in addition to continued rehabilitation.
Future research should focus on detecting biomarkers of early rejection, enhanced
immunosuppression protocols, improved postoperative care and early referral to
transplant centers.