INTESTINAL TRANSPLANTATION. RIGHT WING OR LEFT WING?

Key words: Intestinal insufficiency, Intestinal transplantation, Parenteral nutrition

Intestinal transplantation (IT) is an alternative to lifelong total parenteral nutrition (TPN) for cases of severe intestinal insufficiency with the following characteristics: venous access impossible, TPN-dependent liver disease, recurrent sepsis, severe and recurrent electrolyte disturbances. The 5-year survival rate of TPN is over 85%, while IT has a 5-year survival rate of only 50%, although new immunosuppresive drugs and biological therapy have recently improved the long-term outcome. The overall prognosis of transplanted patients is anyway better than that of TPN patients who are in waiting list for transplantation. Indications to gut transplantation are rare. This fact and the need of highly specialised multidisciplinary team work justifies the existence of only one centre for IT in Italy.