Our Summary

This research paper discusses the concept of pre-emptive transplantation, which is a preventive measure used in certain cases of end-organ failure. For patients who have irreversible intestinal failure, the standard treatment is total parenteral nutrition (TPN). However, for patients who are at high risk of complications and death while on TPN, a pre-emptive transplant could be a potentially life-saving measure. This is because waiting for a transplant has a high mortality rate, particularly for those needing an intestinal transplant.

The researchers suggest that using models or systems to predict outcomes could help choose which patients would benefit most from a pre-emptive transplant. Certain conditions and complications from TPN have been identified as increasing the risk of morbidity and death. These include liver failure, repeated infections, mesenteric infarction, short bowel syndrome, congenital mucosal disease, and desmoid tumors.

However, the researchers caution that these conditions need to be carefully assessed so as not to underestimate the seriousness of the patient’s condition or overestimate the effects of a temporary situation. They also note that other factors, such as diseases with unpredictable trajectories and issues related to quality of life and finances, are not yet considered as reasons for a pre-emptive transplant.

FAQs

  1. What is pre-emptive transplantation and in what circumstances is it used?
  2. What are some conditions that increase the risk of morbidity and death for patients on total parenteral nutrition (TPN)?
  3. Why do researchers caution against overestimating the effects of a temporary situation when considering pre-emptive transplant?

Doctor’s Tip

Overall, the key takeaway is that a pre-emptive intestinal transplant could be a life-saving option for patients with irreversible intestinal failure who are at high risk of complications and death while on TPN. It is important for patients to discuss their individual situation with their healthcare provider to determine if they may be a candidate for a pre-emptive transplant and to weigh the potential risks and benefits. Regular follow-up and monitoring with a healthcare team experienced in intestinal transplantation is essential for successful outcomes.

Suitable For

Overall, patients who are at high risk of complications and death while on TPN due to irreversible intestinal failure are typically recommended for an intestinal transplant. These patients may have conditions such as liver failure, repeated infections, mesenteric infarction, short bowel syndrome, congenital mucosal disease, or desmoid tumors that increase their risk of morbidity and mortality. Using models or systems to predict outcomes can help identify which patients would benefit most from a pre-emptive transplant. However, careful assessment of the patient’s condition is necessary to ensure that the decision is appropriate and not based on temporary factors. Other factors, such as unpredictable disease trajectories and quality of life issues, are not yet considered as reasons for a pre-emptive transplant.

Timeline

Timeline of a patient’s experience before and after intestinal transplant:

Before transplant:

  1. Patient is diagnosed with irreversible intestinal failure and begins treatment with total parenteral nutrition (TPN).
  2. Patient experiences complications such as liver failure, infections, mesenteric infarction, short bowel syndrome, congenital mucosal disease, or desmoid tumors.
  3. Patient’s condition deteriorates, and the risks of morbidity and death while on TPN increase.
  4. Patient is evaluated for a potential pre-emptive intestinal transplant as a life-saving measure.
  5. Patient undergoes thorough assessments to determine eligibility for transplant, including physical, psychological, and financial evaluations.

After transplant:

  1. Patient undergoes intestinal transplant surgery, which involves removing the diseased intestine and replacing it with a healthy donor intestine.
  2. Patient is closely monitored in the intensive care unit post-transplant to watch for signs of rejection or complications.
  3. Patient begins a regimen of immunosuppressive medications to prevent rejection of the transplanted organ.
  4. Patient undergoes regular follow-up appointments and monitoring to ensure the success of the transplant and manage any potential complications.
  5. Patient gradually resumes normal activities and diet as the transplanted intestine begins to function properly.
  6. Patient experiences improved quality of life and reduced risk of complications associated with TPN.

What to Ask Your Doctor

  1. What are the risks and benefits of an intestinal transplant compared to continuing with total parenteral nutrition (TPN)?

  2. How long is the waiting list for an intestinal transplant, and how does the process work?

  3. What criteria do I need to meet in order to be considered for an intestinal transplant?

  4. What are the potential complications and side effects of an intestinal transplant?

  5. What is the success rate of intestinal transplants, and what is the long-term prognosis for patients who undergo this procedure?

  6. How will my quality of life be affected after an intestinal transplant?

  7. Are there any alternative treatments or therapies that I should consider before deciding on an intestinal transplant?

  8. How often will I need to follow up with my medical team after the transplant, and what ongoing care will be required?

  9. Are there any lifestyle changes or dietary restrictions I will need to follow after an intestinal transplant?

  10. How can I best prepare myself physically and mentally for an intestinal transplant procedure?

Reference

Authors: Lauro A, Marino IR, Iyer KR. Journal: Dig Dis Sci. 2017 Nov;62(11):2966-2976. doi: 10.1007/s10620-017-4752-2. Epub 2017 Sep 16. PMID: 28918445