Therapeutic efficacy of intestinal and multivisceral transplantation: survival and nutrition outcome.
The clinical introduction of intestinal transplantation has added a new dimension and offered a valid therapeutic option for patients with irreversible intestinal failure. In the year 2000, the Center for Medicare & Medicaid Services (CMS) recognized intestinal, combined liver-intestinal, and multivisceral transplantation as the standard of care for patients with irreversible intestinal and parenteral nutrition (PN) failure. Accordingly, the indications for the procedure are currently limited to those who develop life-threatening PN complications. However, a recent improvement in survival similar to other solid organ transplant recipients should justify lifting the current restricted criteria, and the procedure should be considered before the development of PN failure. Equally important is the awareness of the recent evolution in nutrition management and outcome after transplantation. Early and progressive enteral feeding using a complex polymeric formula is safe and effective after successful transplantation. Full nutrition autonomy is universally achievable among most intestinal and multivisceral recipients, with enjoyment of unrestricted oral diet. Such a therapeutic benefit is commonly maintained among long-term survivors, with full rehabilitation and restoration of quality of life.
Matarese
Laura E
LE
Thomas E. Starzl Transplantation Institute, Intestinal Rehabilitation and Transplantation Center, UPMC Montefiore, 7 South, 3459 Fifth Avenue, Pittsburgh, PA 15213, USA. mataresele@upmc.edu
Costa
Guilherme
G
Bond
Geoffrey
G
Stamos
June
J
Koritsky
Darlene
D
O'Keefe
Stephen J D
SJ
Abu-Elmagd
Kareem
K
D004750:Enteral Nutrition; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D007410:Intestinal Diseases / Q000601:surgery / Q000628:therapy*; D007422:Intestines / Q000637:transplantation*; D016031:Liver Transplantation; D009747:Nutritional Physiological Phenomena / Q000502:physiology*; D009751:Nutritional Requirements; D010288:Parenteral Nutrition; D011379:Prognosis; D011788:Quality of Life; D016019:Survival Analysis; D019172:Transplantation Conditioning; D023001:Transplantation Tolerance
D007166:Immunosuppressive Agents