Italian guidelines for intestinal transplantation: potential candidates among the adult patients managed by a medical referral center for chronic intestinal failure

Chronic intestinal pseudo-obstruction

“…The main causes of death are TPN-related complications, surgery-related complications, and post-transplantation complication, together with septic shock of GI origin. A variety of clinical, histological and manometric parameters have been found to be predictive of a poor clinical outcome in adult patients, including myopathy and decreased contractile activity [2,50,52,53,[55][56][57][58][59][60] . MNGIE has a particularly poor prognosis with slowly progressive evolution and death around 40 years of age [11] .…”

“…The main limitations of this nutritional support include liver insufficiency, pancreatitis, glomerulonephritis and catheter-related complications (i.e. thrombosis and septicemia) [58,59] .…”

“…Predictors of post-transplant complications are: concomitant neuromuscular disorders of the urinary tract, chronic use of opioids and technical problems determined by previous multiple laparotomies and/or the need of gastrectomy for gastroparesis. Nonetheless, transplantation should be considered when all other therapeutic options have failed according to the following indications: chronic intestinal failure with a high risk of mortality, life-threatening complications of parenteral nutrition, lack of venous access, disease-related poor quality of life despite optimal parenteral nutrition [58] .…”

Colonic Pseudo-Obstruction

“…Increased in morbidity and mortality has been shown when surgical treatment was needed [79] . The mortality rate in medically treated patients is 14% and surgically treated patients is 30%, with a higher mortality in patients with cecal perforation or ischemia [80] .…”

Review article: molecular, pathological and therapeutic features of human enteric neuropathies

“…The main limitations of parenteral nutrition include severe complications such as liver failure, pancreatitis, glomerulonephritis and catheter‐related complications (i.e. thrombosis and sepsis) 137 . In most cases, small bowel bacterial overgrowth is an important cause of diarrhoea and malnutrition, and it should be treated with antibiotic therapy.…”