Clinical contributionLiver transplantation: OutcomeRecovery From Liver Dysfunction After Adult Isolated Intestinal Transplantation Without Liver Grafting
Section snippets
Materials and methods
From December 2000 to December 2005, we transplanted 34 adult patients including 25 (73.5%) who received an isolated intestinal graft (5 with colon, 20 without colon) and 9 (26,5%) a multivisceral graft (5 with liver; Fig 1). Indications for intestinal transplant were intestinal infarction (n = 15), Gardner’s syndrome (n = 8), chronic intestinal pseudo-obstruction (n = 8), massive intestinal angiomatosis (n = 1), intestinal atresia (n = 1), and radiation enteritis (n = 1). Considering that each
Results
At discharge, all patients in the IF-liver disease group recovered from liver dysfunction: mean bilirubin blood level was 0.9 ± 0.96 mg/dL (range, 0.3–1.6) and mean transaminases were 26 ± 9/31 ± 18 IU/mL (range, 10–44/27–65); two patients maintained a PT around 60%. After a mean follow-up of 27 months, only one patient showed an elevated ALT without clinical signs of liver disease: the mean bilirubin level was 0.8 ± 0.5 mg/dL (range, 0.3–1.2 mg/dL), the mean transaminase level 22 ± 10/24 ± 12
Discussion
The standard treatment for patients with irreversible intestinal failure and life-threatening parenteral nutrition-related complications such as liver dysfunction has not yet been established: combined or multivisceral intestinal/liver transplantation, liver transplantation with bowel rescue, gut recovery without transplantation, or isolated intestinal transplant without a liver have been proposed as therapeutic alternations.
IF-liver disease in the setting of the intestinal failure is the most
References (16)
- et al.
Mortality in candidates waiting for combined liver-intestine transplants exceeds that for other candidates waiting for liver transplants
Liver Transpl
(2003) - et al.
Isolated intestinal transplantation for intestinal failure
Am J Gastroenterol
(2000) - et al.
Intestinal transplantation under Tacrolimus monotherapy after peri-operative lymphoid depletion with rabbit anti-thymocyte globulin (Thymoglobulin®)
Am J Transplant
(2005) - et al.
Functional liver recovery parallels autologous gut salvage in short bowel syndrome
J Pediatr Surg
(2004) - et al.
Prevention of liver failure in parenteral nutrition-dependent children with short bowel syndrome
J Pediatr Surg
(1997) - et al.
Isolated liver transplantation for liver failure in patients with short bowel syndrome
J Pediatr Surg
(1994) - et al.
Outcomes after adult isolated small bowel transplantation: experience from a single European center
Dig Liver Dis
(2005) Intestinal and Multivisceral transplantation (#CAG-00036N)Decision memorandum
(2000)
Cited by (5)
Pathogenesis and treatment of parenteral nutrition-associated liver disease
2012, Hepatobiliary and Pancreatic Diseases InternationalBAPEN Symposium 4 on 'Managing complications in long-term parenteral nutrition': Managing liver dysfunction in parenteral nutrition
2007, Proceedings of the Nutrition SocietyPre-emptive Intestinal Transplant: The Surgeon’s Point of View
2017, Digestive Diseases and SciencesRecent advances in the management of intestinal failure-associated liver disease
2009, Current Opinion in Clinical Nutrition and Metabolic CareManaging liver dysfunction in parenteral nutrition
2009, Nutrition, Diet Therapy, and the Liver