Matarese Laura E, Costa Guilherme, Bond Geoffrey, Stamos June, Koritsky Darlene, O'Keefe Stephen J D, Abu-Elmagd Kareem
Thomas E. Starzl Transplantation Institute, Intestinal Rehabilitation and Transplantation Center, UPMC Montefiore, 7 South, 3459 Fifth Avenue, Pittsburgh, PA 15213, USA.
Nutr Clin Pract. 2007 Oct;22(5):474-81. doi: 10.1177/0115426507022005474.
The clinical introduction of intestinal transplantation has added a new dimension and offered a valid therapeutic option for patients with irreversible intestinal failure. In the year 2000, the Center for Medicare & Medicaid Services (CMS) recognized intestinal, combined liver-intestinal, and multivisceral transplantation as the standard of care for patients with irreversible intestinal and parenteral nutrition (PN) failure. Accordingly, the indications for the procedure are currently limited to those who develop life-threatening PN complications. However, a recent improvement in survival similar to other solid organ transplant recipients should justify lifting the current restricted criteria, and the procedure should be considered before the development of PN failure. Equally important is the awareness of the recent evolution in nutrition management and outcome after transplantation. Early and progressive enteral feeding using a complex polymeric formula is safe and effective after successful transplantation. Full nutrition autonomy is universally achievable among most intestinal and multivisceral recipients, with enjoyment of unrestricted oral diet. Such a therapeutic benefit is commonly maintained among long-term survivors, with full rehabilitation and restoration of quality of life.
肠道移植的临床应用为不可逆性肠衰竭患者增添了新的治疗维度并提供了有效的治疗选择。2000年，医疗保险和医疗补助服务中心（CMS）认可肠道移植、肝肠联合移植和多脏器移植为不可逆性肠衰竭和肠外营养（PN）失败患者的治疗标准。因此，目前该手术的适应证仅限于那些出现危及生命的PN并发症的患者。然而，最近与其他实体器官移植受者相似的生存率提高情况应证明放宽当前的严格标准是合理的，并且该手术应在PN失败发生之前予以考虑。同样重要的是要认识到营养管理和移植后结局的最新进展。成功移植后，使用复合聚合物配方进行早期和逐步肠内喂养是安全有效的。大多数肠道和多脏器移植受者普遍能够实现完全营养自主，享受不受限制的口服饮食。这种治疗益处通常在长期存活者中得以维持，实现完全康复并恢复生活质量。
