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Abstract
Intestinal transplant waitlist mortality is higher than for other organ transplants. This is a review to identify the main problems contributing to the high risk of intestinal transplant candidates and to provide recommendations on how to resolve them. Intestinal transplant, home parenteral nutrition, and intestinal rehabilitation articles issued from the main intestinal transplantation centers from 1987 to 2010 were reviewed. The risk factors for adult and child transplant waitlist mortality were parallel to those of parenteral nutrition. Therefore, primary care givers managing patients with intestinal failure should establish a cooperative link to facilities with active intestinal failure programs from the early period, when anticipation for the parenteral nutrition (PN) requirement is more than 50% in the 3 months of initiation. An intestinal failure care program should include or establish an active collaborative relationship with centers performing intestinal rehabilitation and transplantation. Intestinal rehabilitation centers are expected to establish a multiprofessional team composed of medical doctors, nurses, pharmacists, dieticians, surgeons, gastroenterologists, social workers, fund managers, PN-solution providers, and intestinal transplantation surgeons. National registries for patients undergoing intestinal failure should be established, and home-PN providers should participate.
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Table 1.
Risk factors in children with chronic intestinal failure which should trigger cooperation of multiprofessional team or intestinal failure rehabilitation center
Table 2.
Referral criteria to intestinal failure rehabilitation in children
Table 3.
Risk factors in children with chronic intestinal failure which should trigger involvement of intestinal transplant team
| Age ＜1, ＜2 |
| Bilirubin ＞3, ＞6, ＞12, ＞15 g/dL |
| Platelet ＜100,000, ＜50,000 |
| Bridging fibrosis |
| Short bowel syndrome |
| Primary mucosal disorders |
| Ascites, splenomegaly |
Table 4.
Criteria for consultation or referral for intestinal transplantation assessment in children
Table 5.
Risk factors in adults with chronic intestinal failure which should trigger cooperation of multiprofessional team or intestinal failure rehabilitation center
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