Candidacy for intestinal transplantation.

A recent report from the American Small Bowel Transplant Registry (2003) has highlighted the significant progressive increase in graft and host survival to over 80% at 1 yr, suggesting that a new era has dawned, and that soon transplantation may offer an attractive alternative to any patient with permanent intestinal failure. In order to investigate the potential candidacy for small bowel transplantation in Western Europe, 854 home long-term parenteral nutrition (TPN) patients and their physicians were surveyed in nine countries. Their results demonstrated that only a small proportion of patients were considered candidates, but that candidacy was higher in the pediatric population (34% vs 16%, respectively). Despite the general acceptance in the United States that the development of the complication of liver failure in home TPN patients is an indication for urgent transplantation, "immediate candidacy" was only made by physicians in 36% of such adults and 43% of such children. This study reveals that there remains reluctance in Europe to refer patients for transplantation, even when life-threatening complications have developed. Further investigations need to be performed to determine whether this was because of inaccessibility to a transplant center or unfamiliarity with the procedure and its outcomes.