Well-Timed Referral Needed for Intestinal Transplant

Timely referral for intestinal transplantation--a life-saving procedure for patients with irreversible intestinal failure--can reduce mortality rates, according to a new study.

Researchers from nine European countries investigated patient candidacy and physician attitudes toward intestinal transplantation (ITx) among centers that participated in previous European surveys on home parenteral nutrition (HPN). The patients on HPN for benign intestinal failure (IF) were evaluated by a structured questionnaire. Candidacy was assessed by the U.S. Medicare and American Transplantation Society (ATS) criteria, and categorized as one of the following: (1) life-threatening HPN complications, (2) high risk of death because of gastrointestinal disease, (3) IF with high morbidity or patient HPN refusal. Physicians judged candidacy as immediate or potential.

Forty-one centers from nine countries enrolled 688 adults and 166 pediatric patients; 70% of patients were from five countries that collected 60-100% of their HPN patients. Candidacy was 15.7% in adults and 34.3% in pediatrics. Immediate candidacy was required for 14.8% of adult and 15.8% of pediatric candidates (less than 50% of the candidates because of HPN-related liver failure). Among the major contributing countries, candidacy ranged 0.3-0.8 per million inhabitants for adults and 0.9-2 per million inhabitants for pediatric (under 18 years old) candidates. The rate of candidacy and the indications for ITx candidacy differed greatly among age groups and HPN centers, but within countries candidacy was more homogeneous. Physicians had a generally reserved attitude toward ITx. The results were published in the July 2006 issue of the American Journal of Gastroenterology

"Irreversible intestinal failure is a condition which has a deep impact on the patient's health and quality of life; it requires great organizational and economical efforts by the national health care system and professionals,” said lead author Dr. Loris Pironi, an associate professor of internal medicine at the University of Bologna (Italy).

Knowing the criteria for which transplantation may be necessary will enable doctors to refer patients when needed. Patient referrals for transplantation may come too late, and this may increase mortality rates among those on the waiting list.



Related Links:
University of Bologna