The outcome from small bowel transplantation has improved progressively over the past decade.
This improvement raises questions as to whether indications should be broadened from those currently followed based on ‘total parenteral nutrition failure'.
Dr Stephen O'Keefe and colleagues from Pittsburgh assessed the effect of transplantation on nutritional autonomy, organ function, and quality of life in patients with small intestinal failure.
The team measured these outcomes by a validated self-administered questionnaire containing 26 domains and 130 questions.
The research conducted the survey for a minimum of 12 months in a cohort of 46 consecutively transplanted patients between 2003 and 2004.
The team found that 76% of transplanted patients had intestinal failure because of extreme short bowel.
|All patients were weaned from total parenteral nutrition by about 18 days|
|The American Journal of Gastroenterology|
The remainder of the patients had either chronic pseudo-obstruction or porto-mesenteric vein thrombosis.
The researchers noted that all but the porto-mesenteric vein thrombosis patients were dependent on home total parenteral nutrition .
The patients had developed serious recurrent infective complications with or without central vein thrombosis and liver failure.
The team reported that 61% received a liver in addition to a small intestine.
The researchers noted that 5 patients died, of which 2 had chronic graft rejection.
All the remaining patients have graft survival with an average of 1 episode of acute rejection.
The team observed that all patients were weaned from total parenteral nutrition by a median of 18 days, and from tube feeding by day 69.
The researchers found a significant improvement in overall assessment of quality of life, and in 13 of 26 of the specific domains examined.
Dr O'Keefe's team concluded, "Our results confirm the claim that a new era has dawned for small bowel transplantation."
"It can potentially become an alternative to home total parenteral nutrition for the management of permanent intestinal failure, rather than a last-chance treatment for ‘total parenteral nutrition failure'.