Is there a role for 'acute' or 'preemptive' intestinal transplantation?

PURPOSE OF REVIEW: 'Preemptive' transplantation is performed before underlying disease becomes advanced, compromising transplant feasibilities and posttransplant outcome while 'acute' transplant is performed when organ function is compromised and there is life-threatening risk. In intestinal transplantation an indication for transplant is failure of total parenteral nutrition in patients with intestinal insufficiency: liver disease associated with intestinal failure has a primary role in choosing the type of transplant to be performed and in establishing timing of transplantation. RECENT FINDINGS: Development of hepatic dysfunction represents an indication for preemptive intestinal transplantation at less than 1 year of parenteral nutrition. Regression of intestinal-failure liver disease may be achieved by isolated intestinal transplantation without liver grafting when liver disease is reversible. Therefore an early or preemptive indication for intestinal transplantation, in selected cases, represents liver salvage therapy associated with increased survival. Indications for acute intestinal or multivisceral transplant are few and confined to emergency trauma involving liver/bowel integrity and function, but above all the need of retransplant for multivisceral transplant recipients. SUMMARY: A preemptive isolated intestinal transplantation is strongly advised when liver disease occurs (if reversible) while there are only few clinical indications for acute intestinal transplantation (unless a multivisceral retransplant is needed). © 2007 Lippincott Williams & Wilkins, Inc.