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Indications for Transplant


                                              Intestinal & Multi-Visceral Transplantation: Version 7.0

Indications for Intestinal Transplantation
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The only recognized indication for intestinal transplantation is failed total parenteral nutrition (TPN). CMS, through a series of consensus conferences, has defined failed TPN as follows:

• Impending or overt liver failure due to TPN induced liver injury. The clinical manifestations include elevated serum bilirubin and/or liver enzymes, splenomegaly, thrombocytopenia, gastroesophageal varices, coagulopathy, stomach bleeding, or hepatic fibrosis/cirrhosis.

• Thrombosis of the major central venous channels; jugular, subclavian, and femoral veins. Thrombosis of two or more of these vessels is considered a       life-threatening complication and failure of TPN therapy. The sequelae of central venous thrombosis are lack of access for TPN infusion, fatal sepsis due to infected thrombi, pulmonary embolism, Superior Vena Cava syndrome, or chronic venous insufficiency.

• Frequent line infection and sepsis. The development of two or more episodes of systemic sepsis secondary to line infection per year that requires hospitalization indicates failure of TPN therapy. A single episode of line related fungemia, septic shock and/or Acute Respiratory Distress Syndrome are considered indicators of TPN failure.

• Frequent episodes of severe dehydration despite intravenous fluid supplement in addition to TPN. Under certain medical conditions such as secretory diarrhea and non-constructible gastrointestinal tract, the loss of the gastrointestinal and pancreas to biliary secretions exceeds the maximum intravenous infusion rates that can be tolerated by the cardiopulmonary system. Frequent episodes of dehydration are deleterious to all body organs, particularly kidneys and the central nervous system with the development of multiple kidney stones, renal failure, and permanent brain damage.


1 United States. DHHS. CMS. National Coverage Determination. Intestinal and Multi-Visceral Transplantation.  6/26/2006.