Small bowel transplantation: when should it be considered?

Abstract

Short bowel syndrome is characterized by intestinal failure which occurs after extensive resection of the small and sometimes the large intestine. 1 Intestinal failure in this situation has been defined as the inability to maintain a good nutritional status and normal electrolyte balance without artificial nutritional support. 2,3 The advances in long-term parenteral nutrition (PN) have allowed the survival of increased numbers of patients with short bowel syndrome. 4 In most patients, intestinal failure is reversible after a period of PN during which adaptation of the remaining bowel occurs. Factors which influence adaptation are oral feeding with hormonal stimulation, the length and integrity of the remaining bowel and the presence of the ileocaecal valve. Intestinal failure is irreversible in a small number of patients who thus require long-term PN for survival. However, PN itself is associated with side-effects such as catheter-related sepsis, venous thrombosis, metabolic bone disease, liver failure, micronutrient imbalance and restricted venous access. In some patients with irreversible intestinal failure, small bowel transplantation is an alternative to permanent PN and may improve quality of life. 2,3,5,7 We have evaluated the suitability of patients with intestinal failure on HPN for small bowel transplantation.