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Transplant Services

Intestinal transplantation: treatment option for intestinal failure with TPN complications

05/01/2006

Surgery

Small bowel transplantation provides a realistic treatment modality for intestinal failure patients who are not responding to conventional therapy. Despite substantial recent gains in the procedure’s success, only a few specialized centers offer this alternative to patients.

Short bowel syndrome and intestinal failure result in the need for chronic total parenteral nutrition (TPN) administration. Diseases that commonly result in short bowel syndrome or intestinal failure include:

 Congenital and Neonatal Onset
• jejunoileal atresia
• gastroschisis
• necrotizing enterocolitis
• midgut volvulus
• inherited malabsorptive syndrome:
   - tufting enteropathy
   - microvillus inclusion disease
   - villus atrophy
 Acquired
• midgut volvulus
• chronic intestinal pseudo-obstruction
• mesenteric vascular thrombosis
• extensive surgical resection
• inflammatory bowel disease
• abdominal trauma

TPN adaptation and complications

Many patients with short bowel syndrome will adapt with time; the adaptive process usually begins early and maximizes in two to four years. With careful medical and surgical management – including intestinal lengthening procedures – some patients may adapt to the point where they no longer require TPN. Many patients who do not make this adaptation tolerate TPN adequately to rule out the need for more invasive treatment.

Intestinal transplantation can be offered to patients with intestinal failure associated with life-threatening TPN complications whose prognosis without transplantation is worse than that with transplantation. While TPN is safe in the majority of patients, significant life-threatening complications can arise, including liver disease; loss of central venous access; recurrent central venous catheter infections that are associated with metastatic foci, resistant or fungal organisms; and difficult fluid and electrolyte management situations. With improved outcomes, survival after intestinal transplantation can range from 60 percent to 90 percent, depending on the organs transplanted and the condition of the patient at transplantation.

Transplantation options

The types of organs offered are tailored to meet the patients’ individual needs. These include:
• isolated intestinal transplant
• combined liver and intestinal transplant
• multivisceral transplant that can include the liver, stomach, duodenum, pancreas and small bowel

UCLA’s large, multidisciplinary team assesses adult and pediatric patients with intestinal failure and chronic TPN therapy. After an intensive evaluation, program physicians tailor medical and surgical therapies to each patient. All available treatments are considered, including medical and surgical therapies to improve adaptation and transplantation. Program physicians select the treatment option that offers the best longterm prognosis for the patient. UCLA works with the referring medical team to optimize long-term medical care for this challenging group of patients.

Patient referral

UCLA physicians help manage care for short bowel syndrome patients at any stage of disease. Ideally patients should be referred early in order to maximize treatment options.

Referrals can be directed to:
(310) 794-6487 UCLA Intestinal Transplant Program
(310) 825-5318 UCLA Transplant Office
http://www2.healthcare.ucla.edu/transplant/intestinalhome.html

Program personnel

Douglas G. Farmer, M.D.

Suzanne V. McDiarmid, M.D.

Sherilyn Gordon, M.D.

Joanna Colangelo, R.N.
Transplantation coordinator





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