The current status of intestinal transplantation

The aim of this article is to assess the current status of intestinal transplantation.

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.

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.