Intestinal transplantation

In 2008 185 procedures performed in the U.S.

Survival rate 75% at 1 year, 54% at 5 years and 42% at 10 years.

Most recent studies reveal 1 year survival rates of 90% at centers with extensive experience in the procedure (2009).

Useful inpatients with irreversible gut failure with complications of parenteral nutrition, inability to adapt to limitations of intestinal failure and for patients at high risk of death if the native gut is not removed.

In patients on parenteral nutrition intestinal transplantation considered in the presence of recurrent episodes of sepsis, 2 or more episodes of lost central venous access, cholestasis of the liver, development of portal hypertension, repeated episodes of dehydration.

Most childhood transplants are performed for the short bowel syndrome, usually after surgical resection.

A smaller proportion of intestinal transplants in children are performed for congenital enterocyte disorders that cause diarrhea bowel motility abnormalities or malabsorption secondary to polyposis.

Most cases in adults are performed for the short bowel syndrome, as well, caused mainly by Crohn’s disease, mesenteric vascular accidents, trauma, volvulus, or surgical complications.

Increasingly candidates result from complications of obesity surgeries.

May be a treatment option for advanced benign mesenteric tumors.

A treatment option for patients with portal hypertension and splenic thrombosis precludes liver transplantation alone.

1 year survival rate is equal to that of patients treated with parenteral nutrition for gut failure.

Recipients of liver plus intestine have the best long-term prognosis.

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