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Canadian Journal of Gastroenterology and Hepatology
Volume 2017 (2017), Article ID 1069726, 10 pages
https://doi.org/10.1155/2017/1069726
Review Article

Choice of Allograft in Patients Requiring Intestinal Transplantation: A Critical Review

1Intestinal Rehabilitation and Transplantation Program, Recanati/Miller Transplantation Institute, Mount Sinai Medical Center, New York, NY, USA
2Division of Liver Diseases, Mount Sinai Medical Center, New York, NY, USA
3Division of Liver Diseases, Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada

Correspondence should be addressed to Genevieve Huard

Received 5 January 2017; Accepted 5 April 2017; Published 3 May 2017

Academic Editor: Michael Beyak

Copyright © 2017 Genevieve Huard et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Intestinal transplantation (ITx) is indicated in patients with irreversible intestinal failure (IF) and life-threatening complications related to total parenteral nutrition (TPN). ITx can be classified into three main types. Isolated intestinal transplantation (IITx), that is, transplantation of the jejunoileum, is indicated in patients with preserved liver function. Combined liver-intestine transplantation (L-ITx), that is, transplantation of the liver and the jejunoileum, is indicated in patients with liver failure related to TPN. Thus, patients with cirrhosis or advanced fibrosis should receive a combined allograft, while patients with lower grades of liver fibrosis can usually safely undergo ITx. Reflecting their degree of sickness, the waitlist mortality rate and the early posttransplant outcomes of patients receiving L-ITx are worse than IITx. However, L-ITx is associated with better long-term graft and patient survival. Multivisceral transplantation (MVTx), that is, transplantation of the organs dependent on the celiac axis and superior mesenteric artery, can be classified into full MVTx if it includes the liver and modified MVTx if it does not. The most common indications for MVTx are extensive portomesenteric thrombosis and diffuse gastrointestinal pathology such as motility disorders and polyposis syndrome. Every patient with IF should undergo a multidisciplinary evaluation by an experienced ITx team.