J Korean Soc Transplant.  2010 Dec;24(4):248-255.

Management Strategies for Patients with Chronic Intestinal Failure Who Are Potential Candidates for a Future Intestinal Transplant

• Lee MD

Abstract

Intestinal transplant wait-list mortality is higher than for other organ transplants. This is a review to identify the main problems contributing to the high risk of intestinal transplant candidates and to provide recommendations on how to resolve them. Intestinal transplant, home parenteral nutrition, and intestinal rehabilitation articles issued from the main intestinal transplantation centers from 1987 to 2010 were reviewed. The risk factors for adult and child transplant wait-list mortality were parallel to those of parenteral nutrition. Therefore, primary care givers managing patients with intestinal failure should establish a cooperative link to facilities with active intestinal failure programs from the early period, when anticipation for the parenteral nutrition (PN) requirement is more than 50% in the 3 months of initiation. An intestinal failure care program should include or establish an active collaborative relationship with centers performing intestinal rehabilitation and transplantation. Intestinal rehabilitation centers are expected to establish a multiprofessional team composed of medical doctors, nurses, pharmacists, dieticians, surgeons, gastroenterologists, social workers, fund managers, PN-solution providers, and intestinal transplantation surgeons. National registries for patients undergoing intestinal failure should be established, and home-PN providers should participate.

Keyword

Intestines; Organ transplantation; Parenteral nutrition; Risk factors; Waiting lists; Intestinal failure rehabilitation

MeSH Terms

Adult
Aluminum Hydroxide
Carbonates
Child
Financial Management
Humans
Intestines
Organ Transplantation
Parenteral Nutrition
Parenteral Nutrition, Home
Pharmacists
Primary Health Care
Registries
Rehabilitation Centers
Risk Factors
Social Workers
Transplants
Waiting Lists
Aluminum Hydroxide
Carbonates

Reference

References

1). Sweet SC, Wong HH, Webber SA, Horslen S, Guidinger MK, Fine RN, et al. Pediatric transplantation in the United States, 1995–2004. Am J Transplant. 2006; 6:1132–52.

2). Chungfat N, Dixler I, Cohran V, Buchman A, Abecassis M, Fryer J. Impact of parenteral-nutrition associated liver disease on intestinal transplant waitlist dynamics. J Am Coll Surg. 2007; 205:755–61.

3). Kaufman SS, Atkinson JB, Bianchi A, Goulet OJ, Grant D, Langnas AN, et al. .;. American Society of Transplantation. Indications for pediatric intestinal transplantation: a position paper of the American Society of Transplantation. Pediatr Transplant. 2001; 5:80–7.

4). Sudan D, DiBaise J, Torres C, Thompson J, Raynor S, Gilroy R, et al. A multidisciplinary approach to the treatment of intestinal failure. J Gastrointest Surg. 2005; 9:165–76. discussion 176–7.

5). Goulet O. Strategy and management of children with irreversible intestinal failure. 11th International Small Bowel Transplant Symposium; 2009 Sep 9–12; Bologna, Italy. Toronto, Canada: Intestinal Transplant Association;. 2009; 6.

6). Beath S, Pironi L, Gabe S, Horslen S, Sudan D, Mazeriegos G, et al. Collaborative strategies for reduce mortality and morbidity in patients with chronic intestinal failure including those who are referred for small bowel transplantation. Transplantation 2008. 85:: 1378–84.

7). Beath SV, Needham SJ, Kelly DA, Booth IW, Raafat F, Buick RG, et al. Clinical features and prognosis of children assessed for isolated small bowel or combined small bowel and liver transplantation. J Pediatr Surg. 1997; 32:459–61.

8). Lloyd DA, Vega R, Bassett P, Forbes A, Gabe SM. Survival and dependance on home parenteral nutrition: experience over a 25-year period in a UK referral centre. Aliment Pharmacol Ther. 2006; 24:1231–40.

9). Pironi L, Hebuterne X, van Gossum A, Messing B, Lyszkowska M, Colomb V, et al. Candidates for intestinal transplantation: a multicenter survey in Europe. Am J Gastroenterol. 2006; 101:1633–43. quiz 1679.

10). Colomb V, Dabbas-Tyan M, Taupin P, Talbotec C, Revillon Y, Jan D, et al. Long-term outcome of children receiving home parenteral nutrition: a 20-year single center experience in 302 patients. J Pediatr Gastroenterol Nutr. 2007; 44:347–53.

11). Jeppesen PB, Staun M, Mortensen PB. Adult patients receiving home parenteral nutrition in Denmark from 1991–1996: who will benefit from intestinal transplantation? Scand J Gastroenterol. 1998; 33:839–46.

12). Scolapio JS, Fleming CR, Kelly DG, Wick DM, Zinsmeister AR. Survival of home parenteral nutrition-t reated patients: 20 years of experience at the Mayo Clinic. Mayo Clin Proc. 1999; 74:217–22.

13). Pironi L, Paganelli F, Labate AM, Merli C, Guidetti C, Spinucci G, et al. Safety and efficacy of home parenteral nutrition for chronic intestinal failure: a 16-year experience at a single centre. Dig Liver Dis. 2003; 35:314–24.

14). Luman W, Shaffer JL. Prevalence, outcome and associated factors of deranged liver function tests in patients on home parenteral nutrition. Clin Nutr. 2002; 21:337–43.

15). Guarino A, De Marco G. Italian National Network for Pediatric Intestinal Failure. Natural history of intestinal failure, investigated through a national network-based approach. J Pediatr Gastroenterol Nutr. 2003; 37:136–41.

16). BlueCross BlueShield of Tennessee. BlueCross BlueShield of Tennessee Medical policy manual: small bowel/small bowel-liver/multivisceral transplantation [internet]. Cha-ttanooga, TN: BlueCross BlueShield of Tennessee: 2009. Available from:. http://www.bcbst.com/mpmanual/!SSL!/WebHelp/Small_Bowel_Transplants.htm.

17). BlueCross BlueShield Association. Medical Policy Reference Manual. (2002, March). Small bowel/liver and multivisceral transplant (7.03.05). Retrieved June 3, 2003 from BlueWeb.

18). Fryer JP. Intestinal transplantation: an update. Curr Opin Gastroenterol. 2005; 21:162–8.

19). Lee MD. Nutritional support for intestinal transplantation patients. J Korean Soc Health Syst Pharm. 2010; 27:211–8. .(이명덕. 소장이식환자의 영양집중지원. 병원약사회지 2010;27: 211–8.).

20). Cavicchi M, Beau P, Crenn P, Degott C, Messing B. Prevalence of liver disease and contributing factors in patients receiving home parenteral nutrition for permanent intestinal failure. Ann Intern Med. 2000; 132:525–32.

21). Beath SV, Davies P, Papadopoulou A, Khan AR, Buick RG, Corkery JJ, et al. Parenteral nutrition-related cholestasis in postsurgical neonates: multivariate analysis of risk factors. J Pediatr Surg. 1996; 31:604–6.

22). Gura KM, Lee S, Valim C, Zhou J, Kim S, Modi BP, et al. Safety and efficacy of a fish-oil-based fat emulsion in the treatment of parenteral nutrition-associated liver disease. Pediatrics. 2008; 121:e678–86.

23). Araya J, Rodrigo R, Videla LA, Thielemann L, Orellana M, Pettinelli P, et al. Increase in long-chain polyunsaturated fatty acid n-6/n-3 ratio in relation to hepatic steatosis in patients with nonalcoholic fatty liver disease. Clin Sci (Lond). 2004; 106:635–43.

24). Moon JI. Nutritional management in intestinal transplant patients. 11th. Congress of the Parenteral and Enteral Nutrition Society of Asia; 2005 October 1–4; Seoul, Korea. Seoul: Korea Society for Parenteral and Enteral Nutrition;2005. p. 120–3.

25). Gupte GL, Beath SV, Protheroe S, Murphy MS, Davies P, Sharif K, et al. Improved outcome of referrals for intestinal transplantation in the UK. Arch Dis Child. 2007; 92:147–52.

26). Puntis JW, Holden CE, Smallman S, Finkel Y, George RH, Booth IW. Staff training: a key factor in reducing intravascular catheter sepsis. Arch Dis Child. 1991; 66:335–7.

27). Koehler AN, Yaworski JA, Gardner M, Kocoshis S, Reyes J, Barksdale EM Jr. Coordinated interdisciplinary management of pediatric intestinal failure: a 2-year review. J Pediatr Surg. 2000; 35:380–5.

28). Andorsky DJ, Lund DP, Lillehei CW, Jaksic T, Dicanzio J, Richardson DS, et al. Nutritional and other post-operative management of neonates with short bowel syndrome correlates with clinical outcomes. J Pediatr. 2001; 139:27–33.

29). Agostoni C, Axelson I, Colomb V, Goulet O, Koletzko B, Michaelsen KF, et al. .;. ESPGHAN Committee on Nutrition; European Society for Paediatric Gastroenterology. The need for nutrition support teams in paediatric units: A commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr. 2005; 41:8–11. Erratum in: J Pediatr Gastroenterol Nutr 2005;41: 267–71.

30). Torres C, Sudan D, Vanderhoof J, Grant W, Botha J, Raynor S, et al. Role of intestinal rehabilitation program in the treatment of advanced intestinal failure. J Pediatr Gastroenterol Nutr. 2007; 45:204–12.

31). Vanderhoof JA, Langnas AN, Pinch LW, Thompson JS, Kaufman SS. Short bowel syndrome. J Pediatr Gastroenterol Nutr. 1992; 14:359–70.

32). Stringer MD, Puntis JW. Short bowel syndrome. Arch Dis Child. 1995; 73:170–3.

33). Goulet O, Ruemmele F, Lacaille F, Colomb V. Irreversible intestinal failure. J Pediatr Gastroenterol Nutr. 2004; 38:250–69.

34). Kubota A, Okada A, Imura K, Kawahara H, Nezu R, Kamata S, et al. The effect of metronidazole on TPN-associated liver dysfunction in neonates. J Pediatr Surg. 1990; 25:618–21.

35). Levine A, Maayan A, Shamir R, Dinari G, Sulkes J, Sirotta L. Parenteral nutrition associated cholestasis in preterm neonates: evaluation of urosdeoxycholic acid treatment. J Pediatr Endocrinol Metab. 1999; 12:549–53.

36). Lindor KD, Burnes J. Ursodeoxycholic acid for the treatment of home parenteral nutrition-associated cholestasis. A case report. Gastroenterology. 1991; 101:250–3.

37). Newall F, Barnes C, Savoia H, Campbell J, Monagle P. Warfarin therapy in children who require long term total parenteral nutrition. Pediatrics. 2003; 112:e386.

38). Berseth CL, Bisquera JA, Paje VU. Prolonging small feeding volumes early in life decreases the incidence of necrotizing enterocolitis in very low birth weight infants. Pediatrics. 2003; 111:529–34.

39). Kaufman SS. Prevention of parenteral nutrition-associated liver disease in children. Pediatr Transplant. 2002; 6:37–42.

40). Horslen SP, Kaufman SS, Sudan DL, Fox IJ, Shaw BW, Langnas AN. Isolated liver transplantation in infants with total parenteral nutrition-associated end stage liver disease. Transplant Proc. 2000; 32:1241.

41). Hassan KO, Beath SV, McKiernan PJ, Kelly DA, Clarke SE, Pimpilwar A, et al. Difficult management choices for infants with short bowel syndrome and liver failure. J Pediatr Gastroenterol Nutr. 2002; 35:216–9.

42). Sharif K, de Ville de Goyet J, Beath SV, Protheroe S, John P. Transhepatic hickman line placement: improving the stability by surgically assisted radiologic placement. J Pediatr Gastroenterol Nutr. 2002; 34:561–3.

43). Georgeson K, Halpin D, Figueroa R, Vincente Y, Hardin W Jr. Sequential intestinal lengthening procedures for refractory short bowel syndrome. J Pediatr Surg. 1994; 29:316–20. discussion 320–1.

44). Bianchi A. Longitudinal intestinal lengthening and tailoring: results in 20 children. J R Soc Med. 1997; 90:429–32.

45). Bueno J, Ohwada S, Kocoshis S, Mazariegos GV, Dvorchik I, Sigurdsson L, et al. Factors impacting the survival of children with intestinal failure referred for intestinal transplantation. J Pediatr Surg. 1999; 34:27–32. discussion 32–3.

46). Fecteau A, Atkinson P, Grant D. Early referral is essential for successful pediatric small bowel transplantation: the Canadian experience. J Pediatr Surg. 2001; 36:681–4.

47). Fishbein TM, Gondolesi GE, Kaufman SS. Intestinal transplantation for gut failure. Gastroenterology. 2003; 124:1615–28.

48). Messing B, Crenn P, Beau P, Boutron-Ruault MC, Rambaud JC, Matuchansky C. Long-term survival and parenteral nutrition dependence in adult patients with the short bowel syndrome. Gastroenterology. 1999; 117:1043–50.

49). Howard L, Malone M. Current status of home parenteral nutrition in the United States. Transplant Proc. 1996; 28:2691–5.

50). Vantini I, Benini L, Bonfante F, Talamini G, Sembenini C, Chiarioni G, et al. Survival rate and prognostic factors in patients with intestinal failure. Dig Liver Dis. 2004; 36:46–55.

51). Howard JP, Bruce J, Powell-Tuck J. Nutritional support: a course for developing multidisciplinary clinical teams. Education Committee, British Association For Parenteral and Enteral Nutrition. J R Soc Med. 1997; 90:675–8.

52). DiBaise JK, Scolapio JS. Home parenteral and enteral nutrition. Gastroenterol Clin North Am. 2007; 36:123–44. vii.

53). Jeppesen PB, Langholz E, Mortensen PB. Quality of life in patients receiving home parenteral nutrition. Gut. 1999; 44:844–52.

54). Buchman AL, Scolapio J, Fryer J. AGA technical review on short bowel syndrome and intestinal transplantation. Gastroenterology. 2003; 124:1111–34.

55). Malatack JJ, Schaid DJ, Urbach AH, Gartner JC Jr, Zitelli BJ, Rockette H, et al. Choosing a pediatric recipient for orthoptopic liver transplantation. J Pediatr. 1987; 111:479–89.

56). Cowley AD, Cummins C, Beath SV, Lloyd C, van Mourik ID, McKiernan PJ, et al. Paediatric Hepatology Dependency Score (PHD score)-an audit tool. J Pediatr Gastroenterol Nutr. 2007; 44:108–15.

57). Wiesner R, Edwards E, Freeman R, Harper A, Kim R, Kamath P, et al. .;. United Network for Organ Sharing Liver Disease Severity Score Committee. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology. 2003; 124:91–6.

58). Olthoff KM, Brown RS Jr, Delmonico FL, Freeman RB, McDiarmid SV, Merion RM, et al. Summary report of a national conference: Evolving concepts in liver allocation in the MELD and PELD era. December 8, 2003, Washington, DC, USA. Liver Transpl. 2004; 10:A6–22.

59). Shneider BL, Neimark E, Frankenberg T, Arnott L, Suchy FJ, Emre S. Critical analysis of the pediatric end-stage liver disease scoring system: a single center experience. Liver Transpl. 2005; 11:788–95.

60). Horslen S. Organ allocation for liver-intestinal candidates. Liver Transpl. 2004; 10(10 Suppl 2):S86–9.

61). Horslen S, Barr ML, Christensen LL, Ettenger R, Magee JC. Pediatric transplantation in the United States, 1996–2005. Am J Transplant. 2007; 7:1339–58.