MedStar Georgetown University Hospital, MedStar Georgetown Transplant Institute, Washington, DC, USA.
Department of Surgery, Organ Transplant Service, Walter Reed National Military Medical Center, Bethesda, MD, USA.
Am J Transplant. 2018 Jun;18(6):1312-1320. doi: 10.1111/ajt.14715. Epub 2018 Apr 6.
Intestinal failure (IF)-associated liver disease (IFALD) is widely recognized as a lethal complication of long-term parenteral nutrition. The pathophysiology of IFALD is poorly understood but appears to be multifactorial and related to the inflammatory state in the patient with IF. Visceral transplant for IFALD includes variants of intestine, liver, or combined liver-intestine allografts. Graft selection for an individual patient depends on the etiology of IF, abdominal and vascular anatomy, severity of IFALD, and potential for intestinal rehabilitation. The past decade has witnessed dramatic improvement in the management of IFALD, principally due to improved lipid emulsion formulations and the multidisciplinary care of the patient with IF. As the recognition and treatment of IFALD continue to improve, the requirement of liver-inclusive visceral grafts appears to be decreasing, representing a paradigm shift in the care of the patient with IF. This review highlights the current indications, graft selection, and outcomes of visceral transplantation for IFALD.
肠衰竭（IF）相关肝病（IFALD）是长期肠外营养的致命并发症，这已得到广泛认可。IFALD 的病理生理学尚未完全阐明，但似乎是多因素的，与 IF 患者的炎症状态有关。IFALD 的内脏移植包括肠、肝或联合肝肠同种异体移植物的变体。为个体患者选择移植物取决于 IF 的病因、腹部和血管解剖、IFALD 的严重程度以及肠道康复的潜力。过去十年中，IFALD 的管理取得了显著改善，主要归因于改进的脂肪乳剂配方和 IF 患者的多学科护理。随着 IFALD 的认识和治疗不断改善，包含肝脏的内脏移植物的需求似乎在减少，这代表了 IF 患者护理模式的转变。本综述强调了内脏移植治疗 IFALD 的当前适应证、移植物选择和结果。
