INVESTIGADORES
GONDOLESI Gabriel Eduardo
artículos
Título:
Intestinal transplantation for gut failure
Autor/es:
THOMAS FISHBEIN; GABRIEL GONDOLESI; STUART KAUFFMAN
Revista:
GASTROENTEROLOGY
Editorial:
W B SAUNDERS CO-ELSEVIER INC
Referencias:
Lugar: Philadelphia; Año: 2003 p. 1615 - 1628
ISSN:
0016-5085
Resumen:
In recent years, we have witnessed increasing clinical
experience with intestinal transplantation at selected
centers. Although early results with this therapy were
poor, several important advances have led to improved
outcomes. These improvements prompted the Centers
for Medicare and Medicaid Services to issue a memorandum
on October 4, 2000, according federal reimbursement
for intestinal transplantation at selected centers and
for selected indications.1 The Centers for Medicare
and Medicaid Services stipulated that, to qualify for
transplantation, patients must meet a specific definition
of intestinal failure and have experienced failure of
parenteral nutrition (Table 1). In addition, the Centers
for Medicare and Medicaid Services set forth centerspecific
criteria for reimbursement, including 1-year
patient survival rates of at least 65% and minimum
center volume of at least 10 transplants performed per
year. Only 4 centers in the United States currently meet
these criteria (Mount Sinai Medical Center, University of
Pittsburgh Medical Center, University of Miami,
and University of Nebraska Medical Center). Thus, intestinal
transplantation is currently at a crossroads, transitioning
from its historical status as an experimental
therapy to standard care for patients with appropriate
indications.
Presently, appropriate indications, timing of referral,
and outcomes of intestinal transplantation are not well
recognized among physicians caring for patients who
may be candidates for this therapy. Definitions of terms
such as ?intestinal failure? and ?failure of parenteral
nutrition? are not standard, and there is no accepted
algorithm for integrating parenteral nutrition, intestinal
rehabilitation, and transplantation for patients with intestinal
failure. Herein we review (1) the applicability of
intestinal transplantation for patients with intestinal failure,
(2) the current state of medical practice in intestinal
transplantation with an emphasis on recent improvements,
and (3) current results of this therapy. We also
offer for the general gastroenterologist or gastrointestinal
surgeon a rational approach to managing intestinal failure
and integrating intestinal rehabilitation, parenteral
nutrition, and transplantation.2n recent years, we have witnessed increasing clinical
experience with intestinal transplantation at selected
centers. Although early results with this therapy were
poor, several important advances have led to improved
outcomes. These improvements prompted the Centers
for Medicare and Medicaid Services to issue a memorandum
on October 4, 2000, according federal reimbursement
for intestinal transplantation at selected centers and
for selected indications.1 The Centers for Medicare
and Medicaid Services stipulated that, to qualify for
transplantation, patients must meet a specific definition
of intestinal failure and have experienced failure of
parenteral nutrition (Table 1). In addition, the Centers
for Medicare and Medicaid Services set forth centerspecific
criteria for reimbursement, including 1-year
patient survival rates of at least 65% and minimum
center volume of at least 10 transplants performed per
year. Only 4 centers in the United States currently meet
these criteria (Mount Sinai Medical Center, University of
Pittsburgh Medical Center, University of Miami,
and University of Nebraska Medical Center). Thus, intestinal
transplantation is currently at a crossroads, transitioning
from its historical status as an experimental
therapy to standard care for patients with appropriate
indications.
Presently, appropriate indications, timing of referral,
and outcomes of intestinal transplantation are not well
recognized among physicians caring for patients who
may be candidates for this therapy. Definitions of terms
such as ?intestinal failure? and ?failure of parenteral
nutrition? are not standard, and there is no accepted
algorithm for integrating parenteral nutrition, intestinal
rehabilitation, and transplantation for patients with intestinal
failure. Herein we review (1) the applicability of
intestinal transplantation for patients with intestinal failure,
(2) the current state of medical practice in intestinal
transplantation with an emphasis on recent improvements,
and (3) current results of this therapy. We also
offer for the general gastroenterologist or gastrointestinal
surgeon a rational approach to managing intestinal failure
and integrating intestinal rehabilitation, parenteral
nutrition, and transplantation.21 The Centers for Medicare
and Medicaid Services stipulated that, to qualify for
transplantation, patients must meet a specific definition
of intestinal failure and have experienced failure of
parenteral nutrition (Table 1). In addition, the Centers
for Medicare and Medicaid Services set forth centerspecific
criteria for reimbursement, including 1-year
patient survival rates of at least 65% and minimum
center volume of at least 10 transplants performed per
year. Only 4 centers in the United States currently meet
these criteria (Mount Sinai Medical Center, University of
Pittsburgh Medical Center, University of Miami,
and University of Nebraska Medical Center). Thus, intestinal
transplantation is currently at a crossroads, transitioning
from its historical status as an experimental
therapy to standard care for patients with appropriate
indications.
Presently, appropriate indications, timing of referral,
and outcomes of intestinal transplantation are not well
recognized among physicians caring for patients who
may be candidates for this therapy. Definitions of terms
such as ?intestinal failure? and ?failure of parenteral
nutrition? are not standard, and there is no accepted
algorithm for integrating parenteral nutrition, intestinal
rehabilitation, and transplantation for patients with intestinal
failure. Herein we review (1) the applicability of
intestinal transplantation for patients with intestinal failure,
(2) the current state of medical practice in intestinal
transplantation with an emphasis on recent improvements,
and (3) current results of this therapy. We also
offer for the general gastroenterologist or gastrointestinal
surgeon a rational approach to managing intestinal failure
and integrating intestinal rehabilitation, parenteral
nutrition, and transplantation.22