New Insights Into the Indications for Intestinal Transplantation: Consensus in the Year 2019.
New Insights Into the Indications for Intestinal Transplantation: Consensus in the Year 2019.
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DOI：
10.1097/tp.0000000000003065
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发表时间：
2020-05
期刊：
影响因子：
6.2
通讯作者：
Pironi L
中科院分区：
文献类型：
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作者：
Kaufman SS;Avitzur Y;Beath SV;Ceulemans LJ;Gondolesi GE;Mazariegos GV;Pironi L
2001年，发表了一份声明，描述了肠功能衰竭患者的肠道移植适应症，预计无限期地需要肠外营养。自2001年以来，在肠功能衰竭的管理方面，包括移植和病人存活在内，在延长肠外营养和移植后方面取得了进展，导致全世界的肠道移植数量从2008年每年270例的峰值减少到2017年的每年149例。这些变化表明，2001年的原始报表需要重新评估。所有永久性肠衰竭患者都应由专门的多学科肠道康复团队进行治疗。在这些团队的护理下，如果患者出现进行性肠衰竭相关性肝病、进行性失去中心静脉通路，以及反复发生危及生命的中心静脉导管相关性感染需要危重护理时，应考虑进行肠道移植。移植的其他适应症包括巨大的硬纤维瘤和其他合理预期移植后治愈的腹部内肿瘤，广泛的肠系膜静脉血栓形成和肠梗死，全肠神经节细胞缺乏症，以及不可恢复的先天性分泌性腹泻。在成功的肠道移植后，生活质量通常会得到改善，当其他适应症出现时，生活质量可能会支持继续移植的决定。然而，如果仅仅是出于改善生活质量的期望，对终身免疫抑制的要求及其相关的副作用就排除了肠道移植。越来越多的肠移植经验和对移植结果的关键评估，包括移植物存活和患者生活质量，以及免疫抑制方面的潜在进展，预计将影响未来的移植实践。
In 2001, a Statement was published that described indications for intestinal transplantation in patients with intestinal failure expected to require parenteral nutrition indefinitely. Since 2001, advances in the management of intestinal failure including transplantation and patient survival, both on extended parenteral nutrition and after transplantation, have improved, leading to a reduction in the number of intestinal transplants worldwide from a peak of 270 per year in 2008 to 149 per year in 2017. These changes suggest that the original 2001 Statement requires reassessment. All patients with permanent intestinal failure should be managed by dedicated multidisciplinary intestinal rehabilitation teams. Under care of these teams, patients should be considered for intestinal transplantation in the event of progressive intestinal failure–associated liver disease, progressive loss of central vein access, and repeated life-threatening central venous catheter–associated infections requiring critical care. Additional indications for transplantation include large desmoid tumors and other intra-abdominal tumors with reasonable expectation of posttransplant cure, extensive mesenteric vein thrombosis and intestinal infarction, total intestinal aganglionosis, and nonrecoverable congenital secretory diarrhea. Quality of life typically improves after successful intestinal transplantation and may support the decision to proceed with transplantation when other indications are present. However, the requirement for life-long immunosuppression and its associated side effects preclude intestinal transplantation if motivated only by an expectation of improved quality of life. Increasing experience with intestinal transplantation and critical appraisal of transplant outcomes including graft survival and patient quality of life together with potential advances in immunosuppression can be expected to influence transplant practices in the future.