General Criteria
Potential contraindications for solid organ transplant subject to the judgment of the transplant center may include the following:
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Known current malignancy, including metastatic cancer;
or
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Recent malignancy with high risk of recurrence;
or
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Untreated systemic infection making immunosuppression unsafe, including chronic infection;
or
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Other irreversible end-stage diseases not attributed to intestinal failure;
or
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History of cancer with a moderate risk of recurrence;
or
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Systemic disease that could be exacerbated by immunosuppression;
or
- Psychosocial conditions or chemical dependency affecting ability to adhere to therapy.
-
Human Immunodeficiency virus (HIV) disease unless ALL of the following are noted:
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CD4 count greater than 200 cells/mm;
and
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Undetectable HIV-1ribonucleic acid (RNA) viral load;
and
-
Three (3) or more months of stable anti-retroviral therapy;
and
- Absence of opportunistic infections (e.g., aspergillus, tuberculosis, coccidiodi, other resistant fungal infections) or neoplasms (e.g., Kaposi's sarcoma) associated with HIV disease.
Intestinal failure results from surgical resection, congenital defect, or disease-associated loss of absorption, and is characterized by the inability to maintain protein-energy, fluid, electrolyte, or micronutrient balance. Short bowel syndrome is an example of intestinal failure.
Candidates should meet the following criteria:
- Adequate cardiopulmonary status
- Documentation of Individuals compliance with medical management.
Small Bowel-Specific Criteria
Individuals who are developing or have developed severe complications due to total parenteral nutrition (TPN) include, but are not limited to, the following: multiple and prolonged hospitalizations to treat TPN-related complications (especially repeated episodes of catheter-related sepsis) or the development of progressive liver failure. In the setting of progressive liver failure, small bowel transplant may be considered a technique to avoid end-stage liver failure related to chronic TPN, thus avoiding the necessity of a multivisceral transplant. In those receiving TPN, liver disease with jaundice (total bilirubin greater than three (3) mg/dL) is often associated with development of irreversible, progressive liver disease. The inability to maintain venous access is another reason to consider small bowel transplant in those who are dependent on TPN.
Small Bowel/Liver-Specific Criteria
Evidence of intolerance of total parenteral nutrition (TPN) includes, but is not limited to, multiple and prolonged hospitalizations to treat TPN-related complications or the development of progressive but reversible liver failure. In the setting of progressive liver failure, small bowel transplant may be considered a technique to avoid end-stage liver failure related to chronic TPN and would thus avoid the necessity of a multi-visceral transplant.
