Purpose of review: The scope of this manuscript is to review the currently accepted indications and contraindications for intestinal transplantation. The review is timely both because of the improving outcomes with intestinal transplantation and because of the growing recognition that appropriate patient selection and timing of transplantation may allow for much improved outcomes in the entire patient population with intestinal failure. Recent findings: The review hopes to draw attention to the increasing recognition of the need to employ a seamless multi-disciplinary approach in the care of the complex patient with intestinal failure. With recent data suggesting that the patient at increased risk of parenteral nutrition failure can be identified early, it is hoped that potential transplant candidates can be identified early and enjoy improved outcomes even before parenteral nutrition failure and advanced liver disease precludes isolated intestinal transplantation. Summary: Patients with intestinal failure should be managed in 'centers of intestinal excellence' - such centers would have dedicated expertise in all aspects of the care of these patients including medical and nutritional expertise, expertise in autologous gut-salvage procedures and intestinal transplantation. These strategies in concert with early identification of the 'at-risk' patient will allow early isolated intestinal transplantation before the development of end-stage liver disease and identify the patients who may indeed be capable of intestinal adaptation and avoidance of transplantation altogether. Such a seamless approach, will ultimately lead to improved outcomes for all patients with intestinal failure, on an intent-to-treat basis, not just for the patients who proceed to intestinal transplantation.
|Original language||English (US)|
|Number of pages||4|
|Journal||Current opinion in organ transplantation|
|State||Published - Jun 2005|
- Intestinal failure
ASJC Scopus subject areas
- Immunology and Allergy