TY - JOUR
T1 - Visceral transplantation in patients with intestinal-failure associated liver disease
T2 - Evolving indications, graft selection, and outcomes
AU - Hawksworth, Jason S.
AU - Desai, Chirag S.
AU - Khan, Khalid M.
AU - Kaufman, Stuart S.
AU - Yazigi, Nada
AU - Girlanda, Raffaele
AU - Kroemer, Alexander
AU - Fishbein, Thomas M.
AU - Matsumoto, Cal S.
N1 - Publisher Copyright:
© 2018 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2018/6
Y1 - 2018/6
N2 - Intestinal failure (IF)-associated liver disease (IFALD) is widely recognized as a lethal complication of long-term parenteral nutrition. The pathophysiology of IFALD is poorly understood but appears to be multifactorial and related to the inflammatory state in the patient with IF. Visceral transplant for IFALD includes variants of intestine, liver, or combined liver–intestine allografts. Graft selection for an individual patient depends on the etiology of IF, abdominal and vascular anatomy, severity of IFALD, and potential for intestinal rehabilitation. The past decade has witnessed dramatic improvement in the management of IFALD, principally due to improved lipid emulsion formulations and the multidisciplinary care of the patient with IF. As the recognition and treatment of IFALD continue to improve, the requirement of liver-inclusive visceral grafts appears to be decreasing, representing a paradigm shift in the care of the patient with IF. This review highlights the current indications, graft selection, and outcomes of visceral transplantation for IFALD.
AB - Intestinal failure (IF)-associated liver disease (IFALD) is widely recognized as a lethal complication of long-term parenteral nutrition. The pathophysiology of IFALD is poorly understood but appears to be multifactorial and related to the inflammatory state in the patient with IF. Visceral transplant for IFALD includes variants of intestine, liver, or combined liver–intestine allografts. Graft selection for an individual patient depends on the etiology of IF, abdominal and vascular anatomy, severity of IFALD, and potential for intestinal rehabilitation. The past decade has witnessed dramatic improvement in the management of IFALD, principally due to improved lipid emulsion formulations and the multidisciplinary care of the patient with IF. As the recognition and treatment of IFALD continue to improve, the requirement of liver-inclusive visceral grafts appears to be decreasing, representing a paradigm shift in the care of the patient with IF. This review highlights the current indications, graft selection, and outcomes of visceral transplantation for IFALD.
KW - clinical research/practice
KW - intestinal (allograft) function/dysfunction
KW - intestinal disease
KW - intestinal failure/injury
KW - intestine/multivisceral transplantation
KW - liver (native) function/dysfunction
KW - nutrition
UR - http://www.scopus.com/inward/record.url?scp=85044848634&partnerID=8YFLogxK
U2 - 10.1111/ajt.14715
DO - 10.1111/ajt.14715
M3 - Review article
C2 - 29498797
AN - SCOPUS:85044848634
SN - 1600-6135
VL - 18
SP - 1312
EP - 1320
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 6
ER -