[Intestinal transplantation: indications and strategy]

Area of Science:

• Gastroenterology and Hepatology
• Transplant Surgery
• Immunology

Context:

• Intestinal transplantation (ITx) is a recognized treatment for irreversible intestinal failure, extending beyond short bowel syndrome.
• Advancements in immunosuppression (tacrolimus, monoclonal antibodies) and antiviral therapies have significantly enhanced graft and patient survival rates.
• Combined liver-small bowel transplantation demonstrates reduced graft rejection severity, and associated colon grafting is deemed safe.

Purpose:

• To evaluate the efficacy and outcomes of intestinal transplantation as a therapeutic option for patients with irreversible intestinal failure.
• To highlight the improved survival and long-term graft function following advancements in immunosuppressive and supportive therapies.
• To define the critical role of early medico-surgical strategy discussions for optimal ITx timing and patient selection.

Summary:

• Intestinal transplantation can restore long-term intestinal graft function, facilitating parenteral nutrition weaning in adults and supporting normal growth in children.
• ITx is indicated for carefully selected patients with irreversible intestinal failure where long-term parenteral nutrition is no longer a safe alternative.
• Successful ITx requires a comprehensive, multidisciplinary approach, emphasizing timely intervention and optimized perioperative management.

Impact:

• Improved quality of life and long-term survival for patients with irreversible intestinal failure.
• Reduced reliance on long-term parenteral nutrition, mitigating associated complications.
• Established ITx as a viable and effective treatment modality, necessitating early consideration in patient management.