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Visceral transplantation in patients with intestinal‐failure associated liver disease: Evolving indications, graft selection, and outcomes
Author(s) -
Hawksworth Jason S.,
Desai Chirag S.,
Khan Khalid M.,
Kaufman Stuart S.,
Yazigi Nada,
Girlanda Raffaele,
Kroemer Alexander,
Fishbein Thomas M.,
Matsumoto Cal S.
Publication year - 2018
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.14715
Subject(s) - medicine , intestinal failure , short bowel syndrome , liver transplantation , liver disease , transplantation , parenteral nutrition , intensive care medicine , surgery , gastroenterology
Intestinal failure (IF)‐associated liver disease (IFALD) is widely recognized as a lethal complication of long‐term parenteral nutrition. The pathophysiology of IFALD is poorly understood but appears to be multifactorial and related to the inflammatory state in the patient with IF. Visceral transplant for IFALD includes variants of intestine, liver, or combined liver–intestine allografts. Graft selection for an individual patient depends on the etiology of IF, abdominal and vascular anatomy, severity of IFALD, and potential for intestinal rehabilitation. The past decade has witnessed dramatic improvement in the management of IFALD, principally due to improved lipid emulsion formulations and the multidisciplinary care of the patient with IF. As the recognition and treatment of IFALD continue to improve, the requirement of liver‐inclusive visceral grafts appears to be decreasing, representing a paradigm shift in the care of the patient with IF. This review highlights the current indications, graft selection, and outcomes of visceral transplantation for IFALD.