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Intestinal transplantation

Discuss intestinal transplantation?

The intestine is a difficult organ to transplant due to its immunogenicity, large population of donor immune cells present within the graft, and its non sterile contents. Thus intestinal transplantation cannot yet be recommended as an alternative therapy for patients stably maintained on intravenous nutrition.
Intestinal transplantation is currently associated with approximately 80% one year survival and approaching 50% five year survival.

Discuss the current indications for referral of adults to an intestinal transplantation centre in UK?

  • Complications of parenteral nutrition
    • Liver disease (portal hypertension, bridging hepatic fibrosis, or cirrhosis) due to parenteral nutrition— irreversible despite referral and management by an established parenteral nutrition centre.
    • Progressively compromised vascular access for parenteral feeding—loss of all but two major venous access points (one of which should be above the diaphragm).
    • Recurrent or life threatening central line sepsis (including fungal sepsis).
    • Inadequate maintenance on parenteral nutrition for any other reason—for instance, inability to manage hydration/nutrition status despite parenteral nutrition.
  • High risk conditions- Requirement for extensive evisceration (that is, desmoid tumours, trauma, rare selected malignancies including neuroendocrine tumours)

Ref

  1. Based on British Society of Gastroenterology guidelines for Management of Patients with a Short Bowel

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