Update on intestinal rehabilitation after intestinal transplantation.
OBJECTIVE
The past decade has seen improvements in patient selection and a greater range of surgical procedures available to patients with intestinal failure, and this, combined with more effective immunosuppressive regimens, has transformed survival after intestinal transplantation (ITx). Much more is known about optimizing rehabilitation of the engrafted intestine in the first 12 months after transplant, but it is also becoming apparent that there are some long-term health issues to consider.


RESULTS
The key issues in rehabilitation of ITx are the immunogenic nature of the intestinal graft, which means a higher risk of rejection and necessitates relatively high levels of immune suppression that promotes infections, including Epstein-Barr virus-driven lymphoma, viral gastroenteritis and renal impairment; and those related to the specifics of an intestinal allograft (nutritional support, chylous ascites, growth, food allergy, fat soluble vitamin deficiencies, metabolic bone disease). In this article, recent publications about approaches for establishing nutrition and methods for monitoring the health of the ITx patient are reviewed.


CONCLUSIONS
ITx appears to be cost-effective compared with parenteral nutrition, but ITx recipients continue to be vulnerable to infections, nutritional deficiencies and rejection over the long-term and, therefore, require support from and involvement of a multidisciplinary team for patients to become safely integrated with their local community.
The Liver Unit, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, West Midlands, Birmingham B4 6NH, UK.
Girish L
GL
Gupte
Susan V
SV
Beath
D000222:Adaptation, Physiological; D000998:Antiviral Agents / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004750:Enteral Nutrition; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival; D017048:Health Care Costs; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007410:Intestinal Diseases / Q000191:economics / Q000534:rehabilitation* / Q000601:surgery*; D007421:Intestine, Small / Q000276:immunology / Q000637:transplantation*; D007674:Kidney Diseases / Q000209:etiology / Q000517:prevention & control; D007902:Length of Stay; D016377:Organ Transplantation / Q000009:adverse effects / Q000191:economics; D010351:Patient Discharge; D011788:Quality of Life; D013997:Time Factors; D016896:Treatment Outcome; D014777:Virus Diseases / Q000188:drug therapy / Q000209:etiology; D014882:Water-Electrolyte Balance
D000998:Antiviral Agents; D007166:Immunosuppressive Agents