Nutritional management after isolated intestinal transplantation for chronic idiopathic intestinal pseudo-obstruction

Abstract

Intestinal failure is a complicated medical condition resulting in the loss of absorptive area or in severe gastrointestinal bacterial overgrowth. Prolonged use of parenteral nutrition (PN) puts patients at risk of multiple complications, including catheter-related bloodstream infection (CRBSI), intestinal failure-associated liver disease (IFALD), and renal impairment. Intestinal rehabilitation programs (IRPs) have recently been recognized as playing a significant role in outcome improvement, care coordination, and complication prevention. We herein report an adult case of chronic idiopathic intestinal pseudo-obstruction (CIIP) that underwent isolated intestinal transplantation (ITx) from a deceased donor. Because the loss of central vascular access was his indication for ITx, a catheter for perioperative management was inserted in the azygous vein via intercostal veins punctured under ultrasound guidance. A total of 255 cm of small intestine with a 10-cm ascending colon graft was transplanted, and the proximal side was anastomosed to the native duodenum. Because the native gastro-duodenum dysmotility remained even after isolated ITx for CIIP, decompression of the native gastroduodenum with a gastro-jejunum tube via gastrostomy and feeding via tube enterostomy at the graft intestine were needed during the first four to five months after ITx. However, such management was effective in achieving full enteral feeding at an early stage with stable immunosuppressive therapy. Intervention with an IRP for management before ITx helped prevent CRBSIs and facilitated his continuing parenteral nutrition until ITx. Multidisciplinary collaboration on an IRP team is mandatory for the perioperative management of ITx patients.