Long-term outcomes and quality of life after intestine transplantation.

Published

Journal Article (Review)

PURPOSE OF REVIEW: Over the past decade intestine transplantation has been accepted as standard therapy for patients with life-threatening complications of parenteral nutrition. For patients without life-threatening complications, continued therapy with parenteral nutrition has been standard despite seemingly similar patient survival in the short term. It is important to define the long-term patient and graft survival as well as complications encountered late after transplantation in order to understand the role for expansion of the indications for intestinal transplantation. RECENT FINDINGS: Divergent immunosuppression strategies have been proposed by single centers, largely with similar improvements in patient survival over time. Current patient survival in the short term (1 year) and long term (5-10 years) have reached 78-85% and 56-61% in single-center series. Distinguishing the cause of diarrhea after the closure of the ostomy is problematic and justifies the ongoing efforts to identify a biomarker that might be used in place of allograft biopsy. Late rejection episodes are largely related to viral infections or noncompliance and the risk for malignancy appears confined primarily to adult recipients. Nutritional and growth parameters of children more than 2 years after intestinal transplantation demonstrate the majority have excellent bowel function/absorption (albeit frequent eating disorders) and normal growth velocity. Finally, preliminary reports from several new studies of quality of life after intestinal transplantation have been able to correlate the decreases in quality of life described to complications of the transplant or ongoing need for invasive devices or nutritional support. SUMMARY: For patients who undergo intestinal transplantation patient survival appears similar to remaining on parenteral nutrition. The inclination is therefore to move toward earlier transplantation and avoid the need for concomitant liver transplantation. The long-term outcomes, however, are not thoroughly described and at this time it appears premature to electively offer intestinal transplantation.

Full Text

Duke Authors

Cited Authors

  • Sudan, D

Published Date

  • June 2010

Published In

Volume / Issue

  • 15 / 3

Start / End Page

  • 357 - 360

PubMed ID

  • 20445450

Pubmed Central ID

  • 20445450

Electronic International Standard Serial Number (EISSN)

  • 1531-7013

Digital Object Identifier (DOI)

  • 10.1097/MOT.0b013e3283398565

Language

  • eng

Conference Location

  • United States