Update on intestinal rehabilitation after intestinal transplantation

Abstract

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.

Intestinal Transplant Registry Report: Global Activity and Trends

“…This change is likely a result of the improved ability of specialized, interdisciplinary intestine failure units to prevent or resolve intestinal failure associated liver disease (IFALD) which has diminished demand (11,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29). It is unlikely that this change is due to a deficiency in case reporting since (1) a similar trend is documented in the most recent Scientific Registry of Transplant Recipients 2011 Annual Report for the Intestine (http://srtr.transplant.hrsa.…”

“…More than 10 years have passed since the last published report (1,2). Since that time, individual centers have reported significant progress in the outcomes of intestine transplantation (IT) (3)(4)(5)(6)(7)(8)(9)(10)(11)(12), but case volumes have remained relatively small at each center potentially limiting the generalizability of this information. The ITR is unique in that it has captured nearly all IT performed worldwide since its inception and therefore, has the significant advantage in case numbers over single center or national reports.…”

Intestinal transplantation: Current status and future directions

“…Chronic rejection occurs in approximately 15% of recipients, and is the predominant cause of delayed allograft failure and enterectomy 18 . It is mediated by gradual arteriosclerosis of medium‐sized mesenteric vessels, and results in chronic malabsorption 37 . Interestingly, rates of chronic rejection are significantly lower in patients with liver containing allografts (liver–intestine and full multivisceral) than liver‐free allografts, confirming a protective immunomodulating effect of the liver 38 .…”

“…The aim is to commence enteral feeding as early as possible after transplantation. Ileus usually persists for the first few postoperative days as ischemia–reperfusion injury resolves 37 . Most centers introduce enteral intake between 3 and 7 days postoperatively, with some waiting until stomal output is demonstrated 32 .…”

“…Chylous ascites might develop, and require repeated paracentesis over a period of weeks. In the event of this complication, most centers prefer a low‐dose lipid formulation (1 g/kg or 1 g/100 mL feed) initially, with or without medium chain triglycerides; these are absorbed via the portal circulation, rather than lymphatics 37 . Patients are also informed to avoid a high intake of simple carbohydrates and sugars, such as those contained in fruit, fruit juices, and soft drinks, as these can cause osmotic diarrhea.…”