Indications and Timing for Intestinal/Multivisceral Transplantation

The progress in intestinal rehabilitation therapy has modified the strategy of treatment of CIF, moving from a straight referral for ITx of any patients with a potential risk of death on HPN to the early referral of patients to intestinal rehabilitation centers with expertise in both medical and surgical treatment for CIF, in order to maximize the opportunity of weaning off HPN, to prevent HPN-failure, and to ensure timely ITx when this is needed (19). Recent data indicate that only liver failure due to IFALD and invasive intra-abdominal desmoids are the criteria for a straight referral for ITx. CVC-related thrombosis of ≥ 2 central veins could be also considered for a life-saving ITx, in appropriately selected patients. For patients having none of the above criteria, ITx might have a potential rehabilitative role but a careful decision must be taken on a case-by-case basis for adequately informed patients.