ABSTRACT
In recent years, survival following intestinal transplantation has improved so that one-year patient survival at the major, experienced centers has outcomes similar to that of liver transplantation. Most intestinal transplantation candidates have a history of repeated abdominal surgery and resulting loss of abdominal domain. Recent success with the use of IV fish oil emulsions and other lipid-sparing strategies, and indeed improved understanding of parenteral nutrition-associated liver disease, has brought in its wake new challenges for intestinal transplantation. Reversal of biochemical cholestasis in the patient with extreme short bowel, who may still have advanced histological liver injury, creates a therapeutic dilemma in terms of choice of organs for the patient being considered for intestinal transplantation. Current allocation systems do not offer any prioritization for histological liver disease, forcing an often difficult choice between a prolonged wait for a combined liver–small bowel graft or an isolated intestinal transplant with unknown but presumably higher risks of liver decompensation.
