Italian guidelines for intestinal transplantation: potential candidates among the adult patients managed by a medical referral center for chronic intestinal failure.
In 2002, the Italian guidelines for eligibility of patients for intestinal transplantation (ITx) were defined as: life-threatening complications of home parenteral nutrition (HPN), lack of venous access for HPN, locally invasive tumors of the abdomen, Chronic intestinal failure (CIF) with a high risk of mortality, primary disease-related poor quality of life (QoL) despite optimal HPN. Our aim was to identify potential candidates for ITx according to these national guidelines among patients managed by a medical referral center for CIF. Records of patients who received HPN were reviewed. CIF was considered reversible or irreversible (energy by HPN <50% or >50% basal energy expenditure). Patients with irreversible CIF were considered eligible for ITx in the absence of a contraindication, as are used for solid organs Tx. From 1986 to 2003 among 64 patients who met the entry criteria 23 showed reversible and 41 irreversible, CIF. Twenty-one patients with irreversible CIF had an indication for ITx, but eight had also contraindications; thus 13 were eligible, including intestinal pseudo-obstruction (n = 6), mesenteric ischemia (n = 3), Crohn's (n = 2), radiation enteritis (n = 1), and desmoid (n = 1). Indications for ITx included HPN liver failure (n = 2), lack of venous access (n = 2), CIF with high risk of mortality (n = 3), very poor QoL (n = 6 including 5 with pseudo-obstruction). According to the Italian guidelines for ITx, 31% of patients with irreversible CIF managed by a medical referral center were eligible for ITx. Primary disease-related poor QoL was the indication in half of them. Studies on the QoL after ITx are required to allow patients to make an educated decision.
Pironi
L
L
Intestinal Failure Centre, Department of Internal Medicine and Gastroenterology, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy. loris.pironi@unibo.it
Spinucci
G
G
Paganelli
F
F
Merli
C
C
Masetti
M
M
Miglioli
M
M
Pinna
A D
AD
D000328:Adult; D002908:Chronic Disease; D003424:Crohn Disease / Q000601:surgery; D006801:Humans; D007410:Intestinal Diseases / Q000601:surgery*; D007422:Intestines / Q000637:transplantation*; D007558:Italy; D008499:Medical Records; D008875:Middle Aged; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D012017:Referral and Consultation; D012189:Retrospective Studies; D012778:Short Bowel Syndrome / Q000601:surgery; D014184:Transplantation, Homologous / Q000592:standards*; D016896:Treatment Outcome