Long-term outcomes and quality of life after intestine transplantation

Over the past decade intestine transplantation has been accepted as standard therapy for patients with life-threatening complications of parenteral nutrition. For patients without life-threatening complications, continued therapy with parenteral nutrition has been standard despite seemingly similar patient survival in the short term. It is important to define the long-term patient and graft survival as well as complications encountered late after transplantation in order to understand the role for expansion of the indications for intestinal transplantation.

Divergent immunosuppression strategies have been proposed by single centers, largely with similar improvements in patient survival over time. Current patient survival in the short term (1 year) and long term (5-10 years) have reached 78-85% and 56-61% in single-center series. Distinguishing the cause of diarrhea after the closure of the ostomy is problematic and justifies the ongoing efforts to identify a biomarker that might be used in place of allograft biopsy. Late rejection episodes are largely related to viral infections or noncompliance and the risk for malignancy appears confined primarily to adult recipients. Nutritional and growth parameters of children more than 2 years after intestinal transplantation demonstrate the majority have excellent bowel function/absorption (albeit frequent eating disorders) and normal growth velocity. Finally, preliminary reports from several new studies of quality of life after intestinal transplantation have been able to correlate the decreases in quality of life described to complications of the transplant or ongoing need for invasive devices or nutritional support.

For patients who undergo intestinal transplantation patient survival appears similar to remaining on parenteral nutrition. The inclination is therefore to move toward earlier transplantation and avoid the need for concomitant liver transplantation. The long-term outcomes, however, are not thoroughly described and at this time it appears premature to electively offer intestinal transplantation.