Advances in Intestinal Transplantation
Intestinal transplantation emerged as a treatment for intestinal failure after the advent of tacrolimus (TAC) in 1990. Despite the progress and recent advances, intestinal transplantation is a therapeutic option only for patients with intestinal failure whose condition continues to decline in spite of total parenteral nutrition (TPN) therapy. Intestinal transplantation is not yet an alternative for patients who are doing well on TPN. Three-year patient survival after isolated intestine transplantation is approximately 70%, which is appreciably better than in earlier eras, but not comparable with 3-year survival in at-home, stable, TPN-treated patients (90%). Patients failing TPN therapy, however, have a very poor prognosis (< 20% 1-year survival). Intestinal transplantation in this select group of patients with TPN-dependence and life-threatening complications from TPN does offer a clear survival advantage. It is essential that patients failing therapy with TPN be referred early for evaluation for intestinal transplantation to increase the likelihood of a successful outcome. Timely referral also decreases the likelihood of requiring combined liver-intestine transplantation for TPN-induced liver failure. Finally, it is essential that patients with end-stage bowel disease are cared for and managed by a multidisciplinary team at a center that has expertise in all aspects of treatment for intestinal failure: TPN, reconstructive surgery of the bowel, and intestinal transplantation.