de Cos A I, Gómez Candela C, Vázquez C, López Santamaría M, Vicente E
Unidad de Nutrición, Unidad de Trasplante Intestinal, H. La Paz, Madrid, España.
Nutr Hosp. 2003 Nov-Dec;18(6):325-30.
Failure of the intestine, whether due to functional or anatomical reasons, constrains Parenteral Nutrition Therapy in children or adults who, as a result of intestinal resections, alterations in motility, diseases of the microvilli or other reasons, present insufficient intestine to cover their needs in terms of nutrients and fluids. Nonetheless, the maintenance of support with parenteral nutrition at home in subjects with irreversible intestinal failure is not without life-threatening complications: liver disease, recurrent sepsis and loss of central routes recommend the assessment of the indication of intestinal transplant in this group of patients. The incidence of morbidity and mortality after intestinal transplant is greater than in other transplants (kidney, liver), but the long-term survival is around 50-60%. In Spain, 7 transplants (6 children and 1 adult) have been performed so far: 3 of intestine alone, 3 of liver plus intestine and 1 mutivisceral transplant. In 4 cases, the indication for transplant was due to terminal liver disease, with the remainder being due to the loss of venous access, intractable diarrhoea and intra-abdominal desmoid tumour, respectively. Except for one girl who presented severe rejection of the graft, the rest achieved digestive autonomy. One boy has presented lymphocyte neoplasia (PTLD) after 2 years and another died after the transplant as a result of a routine liver biopsy (with functioning grafts). Of the 38 patients assessed for transplant, 18 were considered as candidates and of these, three youthful candidates for hepato-intestinal transplant (with short intestine syndrome) have died while on the waiting list and a fourth in the operating theatre prior to an attempted multivisceral transplant. Intestinal transplants must not be considered as the last desperate therapeutic option in patients with permanent intestinal failure. The type of graft, clinical expertise and the use of new inducers (Sirulimos) all contribute to the results of this therapy, in which survivors remain free from parenteral support and can take up once more their day-to-day activities, can improve over time.
肠道功能衰竭，无论是由于功能性还是解剖学原因，都会限制儿童或成人的肠外营养治疗。这些儿童或成人由于肠道切除、动力改变、微绒毛疾病或其他原因，肠道功能不足以满足其营养和液体需求。然而，对于不可逆性肠道衰竭患者，在家中维持肠外营养支持并非没有危及生命的并发症：肝病、反复败血症和中心静脉通路丧失提示应评估这组患者的肠道移植指征。肠道移植后的发病率和死亡率高于其他移植（肾脏、肝脏），但长期生存率约为50%-60%。在西班牙，到目前为止已进行了7例移植手术（6例儿童和1例成人）：3例单纯肠道移植，3例肝脏加肠道移植，1例多脏器移植。4例移植指征是终末期肝病，其余分别是由于静脉通路丧失、顽固性腹泻和腹腔内硬纤维瘤。除一名女孩出现严重的移植物排斥反应外，其余患者均实现了消化自主。一名男孩在移植后2年出现淋巴细胞瘤（PTLD），另一名男孩在移植后因常规肝脏活检（移植物功能良好）死亡。在评估移植的38例患者中，18例被认为是候选者，其中3例年轻的肝肠移植候选者（短肠综合征）在等待名单上死亡，第4例在尝试进行多脏器移植前在手术室死亡。肠道移植不应被视为永久性肠道衰竭患者的最后绝望治疗选择。移植物类型、临床专业知识以及新型诱导剂（西罗莫司）的使用都对这种治疗的结果有影响，在这种治疗中，幸存者无需肠外支持，能够重新开始日常活动，并且随着时间的推移会有所改善。
