Irreversible intestinal failure, nutrition support, and small bowel transplantation

OBJECTIVES: Prolonged total parenteral nutrition (TPN) is a palliative but life-saving treatment for patients with irreversible intestinal failure (HF ). During the past few years, intestinal transplantation (ITx) has become t he most realistic alternative to TPN. METHODS: We identified potential candidates for ITx, reported clinical data of the international Intestinal Transplant Registry, and analyzed the inte stinal function after transplantation and the common nutrition strategies u sually adopted in the recipients. RESULTS: At present, candidates for ITx are patients with IIF who develop a life-threatening complication during TPN treatment. During the past few ye ars, clinical results have improved mainly in relation to the progress in i mmunosuppression, but prevention of the acute cellular rejection (ACR) is s till the key point. ACR, high doses of immunosuppressant drugs, and intesti nal bacterial translocation can exacerbate intestinal malabsorption and sus tain systemic complications such as sepsis and multiorgan failure. Early en teral alimentation is started after ITx and gradually increased. To prevent dehydration and malnutrition, caused by persistent diarrhea, parenteral nu trition is frequently maintained for 1 to 2 mo. More than 66% of long-term recipients become nutritionally independent of TPN. CONCLUSIONS: ITx is now a life-saving option for patients with IIF and seve re complications from TPN. Clinical and nutritional management of the recip ients is a complex procedure and requires a great deal of expertise. After transplantation most adults maintain adequate nutrition status and children have normal growth. Multiple episodes of ACR, early and persistent dehydra tion, and malabsorption are still common problems that influence the recipi ent's quality of life. Nutrition 2001;17:747-750. (C) Elsevier Science Inc. 2001.