The management of
intestinal failure has evolved dramatically in the last decade. This evolution has been in equal part due to continued improvements in outcomes of intestinal
transplantation and to recognition of the need for multidisciplinary management of the patient with
intestinal failure. This has led to establishment of intestinal rehabilitation programs, centered only in some instances at institutions with established intestinal transplant programs. Alongside this, improved management of
parenteral nutrition-associated
liver disease is creating a paradigm shift in both
intestinal-failure management and in the evolving indications for intestinal
transplantation. Unsolved challenges remain: A persistent mortality on the waiting list, especially for patients awaiting combined liver-intestine transplant; late graft loss to chronic rejection, especially in isolated intestine transplant; the role of antibody-mediated rejection; and
transplantation in the highly sensitized patient continue to defy satisfactory
solution. Notwithstanding these challenges, overall outcomes for patients with
intestinal failure are vastly improved today and are approaching those for patients with end-stage renal and
liver disease. This review will focus on a comprehensive approach to the patient with
intestinal failure, including an overview of intestinal rehabilitation and
transplantation.
Transplantation outcomes and
transplantation of the patient with
liver disease are covered elsewhere.