Internistic management
Inpatients as well as evaluation regarding small bowel transplantation
Small bowel transplant
Over the last 20 years, small bowel transplantation has established itself in the medical care of short bowel syndrome patients. This is due to the poor prognosis for patients on long-term parenteral nutrition, as well as the enormous progress in transplantation medicine.
Currently the one-year survival rate for both the transplanted organ and the patient are at about 80%. New immunosuppressive protocols indicate further future improvements in survival rates after transplantation. Small bowel transplantation is indicated if the small intestine does not function sufficiently anymore and simultaneously parenteral nutrition leads to complications such as port infections, vascular complications, liver enzyme elevations and diabetes mellitus.
Early referral to a multidisciplinary short bowel medical center with the option to have a small bowel transplantation is urgently recommended to set the date of a possible transplant indication in a timely manner.
More progressed stages of the desease require multivisceral transplantation and, possibly, a transplantation is no longer feasible. Depending on the course of the desease, a passive listing for transplantation is possible ie one has the possibility to be actively listed, if required.
Multivisceral transplantation
Depending on the cause and extent / course of the disease, a multivisceral transplantation may combine the transplantation of the liver, small intestine, pancreas and kidney. Such decisions should only be made if no other appropriate therapeutic options are available for the patient. In the case of the short bowel syndrome, patients often develop – over many years of parenteral nutrition – a fatty liver, possibly fatty liver hepatitis, which may possibly result in liver cirrhosis. These patients may then require a combined liver / small intestine transplantation. Other complications of parenteral nutrition may be the development of insulin resistance and thus the development of diabetes mellitus. In specific cases, a combined transplantation may also include the pancreas.
The medical care for patients with short bowel syndrome is only doable on the basis of an optimized cooperation of various disciplines in medicine. The developments of parenterally administered nutrition often do not lead to bigger complications, even after many years of this mode of nutrition. Taking care of possibly occurring complications via a close cooperation between the disciplines involved also plays a significant role in the care for patients. New and innovative approaches are also being developed for patients with short bowel syndrome. A focal point – in this context – is recovering the functionality of the small intestine. Cell-therapeutic approaches as well as the use of stem cells could play a role here in the future.
