O'Keefe Stephen J D, Emerling Maureen, Koritsky Darlene, Martin Dolly, Stamos June, Kandil Hossam, Matarese Laura, Bond Geoffrey, Abu-Elmagd Kareem
Intestinal Rehabilitation and Transplant Center, Pittsburgh, Pennsylvania, USA.
Am J Gastroenterol. 2007 May;102(5):1093-100. doi: 10.1111/j.1572-0241.2007.01125.x. Epub 2007 Mar 22.
The outcome from small bowel transplantation (SBTx) has improved progressively over the past decade raising questions as to whether indications should be broadened from those currently followed based on "TPN (total parenteral nutrition) failure."
To assess current outcome, we studied the effect of transplantation on nutritional autonomy, organ function, and quality of life (QoL) measured by a validated self-administered questionnaire containing 26 domains and 130 questions, for a minimum of 12 months in a cohort of 46 consecutively transplanted patients between June 2003 and July 2004. The majority of transplanted patients (76%) had intestinal failure because of extreme short bowel, the remainder having either chronic pseudo-obstruction or porto-mesenteric vein thrombosis (PMVT). All but the PMVT patients were dependent on home TPN (HPN) (median 2, range 0-25 yr) and had developed serious recurrent infective complications with (25%) or without central vein thrombosis and liver failure. Sixty-one percent received a liver in addition to a small intestine.
Follow-up was for a mean of 21 (range 12-36) months. Five patients died, two with chronic graft rejection. All the remaining patients have graft survival with an average of 1.2 (range 0-5) episodes of acute rejection. All patients were weaned from TPN by a median of 18 days (range 1-117 days) and from tube feeding by day 69 (range 22-272 days). There was a significant improvement in overall assessment of QoL and in 13 of 26 of the specific domains examined.
Our results confirm the claim that a new era has dawned for SBTx, such that, with continued progress, it can potentially become an alternative to HPN for the management of permanent intestinal failure, rather than a last-chance treatment for "TPN failure."
在过去十年中，小肠移植（SBTx）的疗效逐步改善，这引发了关于适应证是否应从目前基于“全胃肠外营养（TPN）失败”所遵循的标准进行拓宽的问题。
为评估当前疗效，我们研究了移植对营养自主性、器官功能和生活质量（QoL）的影响，通过一份经过验证的包含26个领域和130个问题的自填式问卷进行测量，对2003年6月至2004年7月期间连续移植的46例患者进行了至少12个月的随访。大多数移植患者（76%）因小肠极度短小而出现肠衰竭，其余患者患有慢性假性肠梗阻或门静脉肠系膜静脉血栓形成（PMVT）。除PMVT患者外，所有患者均依赖家庭TPN（HPN）（中位时间2年，范围0 - 25年），并出现了严重的反复感染并发症，伴有（25%）或不伴有中心静脉血栓形成和肝功能衰竭。61%的患者除小肠外还接受了肝脏移植。
随访平均时间为21（范围12 - 36）个月。5例患者死亡，2例死于慢性移植物排斥反应。其余所有患者的移植物均存活，平均发生1.2（范围0 - 5）次急性排斥反应。所有患者均在中位时间18天（范围1 - 117天）时停止TPN，在第69天（范围22 - 272天）时停止管饲。在QoL的总体评估以及所检查的26个特定领域中的13个领域中，有显著改善。
我们的结果证实了这样一种说法，即SBTx的新时代已经到来，随着持续进展，它有可能成为治疗永久性肠衰竭的HPN替代方案，而不是“TPN失败”的最后一线治疗方法。
