The New Face of Intestinal and Multivisceral Transplantation

The first isolated intestinal transplant was described almost 50 years ago and it has been 30 years since the first multivisceral transplant was performed. Even though there has been remarkable progress after 4 decades, intestinal transplantation remains a rare event and is only performed by a handful of centers throughout the world. Improvements in surgical techniques, critical care, immunosuppressive drugs, and immune monitoring combined with a better understanding and management of complications has resulted in excellent outcomes in the modern era, even comparable to other solid organ transplants.

In the last decade, new indications came along with improvements in outcomes. Other than the traditional patient with short-gut syndrome and life-threatening complications from the total parenteral nutrition (TPN), indications now include the following:

• Complex portomesenteric thrombosis (where liver transplant is not technically possible) 
• Slow-growing and nonresectable intra-abdominal tumors (neuroendocrine/ desmoid tumors) 
• Gastrointestinal pseudo-obstruction (and other severe dysmotility disorders) 
• Abdominal catastrophes (trauma, open abdominal cavity, multiple enteric fistulas) 
• Quality of life

Perioperatory mortality is rare in experienced hands and hospital stay has been decreasing drastically, with several patients leaving the hospital in fewer than 3 weeks with no central lines and complete enteral autonomy. Most of the patients achieve enteral autonomy in 2 to 3 weeks after the transplant and do not require any additional nutrition or hydration other than by mouth.

Intestinal transplantation has proved to be cost effective when compared to TPN. After 2.5 years, transplant has become more cost effective compared to all the costs related to parenteral nutrition. Quality of life is another point in favor of transplant. Patients report going back to their regular activities. Freedom from lines and their complications is one of the highlights for patients.

Intestinal and multivisceral transplantation is not free of complications. One of the main factors affecting the final outcome is the patient condition at the time of the surgery. Patients coming from home perform much better than patients coming from the hospital at the time of transplant. For this reason, early referral to a specialized intestinal transplant center is fundamental for better outcomes. It is common to be referred patients who already have limited vascular access, TPN induced liver disease, and multiple infections. In some cases, complete lack of central venous access can preclude the transplant.

Intestinal and multivisceral transplantation has now evolved to be a valid therapy for complex patients, restoring the physiology of the abdominal cavity, the ability to eat and at the same time eradicating the baseline disease.

Address for correspondence: Rodrigo Vianna, MD, Jackson Memorial Hospital, University of Miami Miller School of Medicine, 1801 NW 9th Ave. #303, Miami, Florida 33136, United States. Email: r.vianna@med.miami.edu.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no disclosures related to the content of this manuscript.

Suggested citation: Vianna R, Beduschi T. The new face of intestinal and multivisceral transplantation. Intervent Oncol 360. 2014;(2)2:E6-E7.