Small Bowel Transplantation

Parenteral Nutrition (PN) is the primary therapeutic option for Intestinal Failure (IF) patients and Intestinal Transplant (ITx) has a potential life saving role for those patients with Parenteral Nutrition failure. Most IF patients are not referred for ITx until irreversible PN Associated Liver Disease (PNALD) has developed and they need a liver transplant also, leading to inferior outcomes compared to patients referred earlier for isolated ITx. Intestinal Rehabilitation attempts to optimize the function of the intestine with the goal of subsequently weaning PN completely or partially while expediting the identification of cases not weanable from PN and at highest risk of PN failure, where early ITx needs to be considered. Collaboration with intestinal rehabilitation centers should be initiated for IF patients if PN requirements are anticipated to be 50% or more at 3 months from the initiation of therapy. Outcomes with intestinal transplantation are steadily improving, with one-year patient survival rates for isolated ITx being similar to liver transplant.