For referring clinicians
Intestinal Transplant Evaluation and Referral
Intestinal transplantation may be considered for a small subset of patients with irreversible intestinal failure who develop serious complications despite optimized medical, nutrition, and intestinal rehabilitation care.
AIRI helps evaluate and manage patients with intestinal failure and coordinates referral to an intestinal transplant center when transplant evaluation may be appropriate.
When is intestinal transplant considered?
For most patients with chronic intestinal failure, parenteral nutrition and intestinal rehabilitation remain the foundation of treatment. Intestinal transplantation is generally reserved for patients who develop serious or life-threatening complications of intestinal failure or long-term parenteral nutrition.
Evaluation may become appropriate when complications such as progressive intestinal failure-associated liver disease, loss of central venous access, or recurrent life-threatening central-line infections make continued parenteral nutrition increasingly difficult or unsafe.
When to consider referral for transplant evaluation
Referral to an intestinal transplant center may be considered when a patient with irreversible intestinal failure develops one or more of the following:
Progressive liver disease
Progressive intestinal failure-associated liver disease related to long-term parenteral nutrition may warrant transplant evaluation, particularly when there are signs of advanced liver dysfunction.
Loss of central venous access
Progressive thrombosis or loss of major central veins can threaten the ability to safely continue long-term parenteral nutrition and is an important reason to consider early referral.
Life-threatening line infections
Recurrent severe central venous catheter-associated infections, particularly infections requiring critical care, may indicate that continued parenteral nutrition carries substantial risk.
Other high-risk conditions
Certain complex conditions, including extensive mesenteric vascular disease or selected abdominal tumors, may also lead a specialized transplant center to consider intestinal or multivisceral transplantation.
Intestinal rehabilitation remains an important part of care
The need for long-term parenteral nutrition does not by itself mean that a patient needs an intestinal transplant. Many patients with intestinal failure can be managed with specialized nutrition support, medical therapy, and intestinal rehabilitation.
Before transplant becomes necessary, the care team should evaluate intestinal anatomy, nutrition and hydration needs, parenteral nutrition requirements, medications, central venous access, complications, and the potential for intestinal adaptation or other rehabilitative strategies.
For some patients, intestinal function may improve enough to reduce dependence on parenteral nutrition or IV fluids over time. For others, transplant evaluation may become appropriate as complications progress.
Why early evaluation matters
Transplant referral does not mean that a patient will proceed directly to transplantation. Evaluation allows a specialized transplant team to assess the patient's intestinal failure, remaining venous access, liver function, underlying disease, comorbidities, and overall transplant candidacy.
Early referral can be particularly important when central venous access is progressively being lost or liver disease is worsening. Waiting until complications become advanced may limit treatment options and make transplantation more complex.
Types of intestinal transplant
The organs included in a transplant depend on the patient's underlying disease, liver function, anatomy, and other clinical factors. A transplant center determines the appropriate approach after a comprehensive evaluation.
Isolated intestinal transplant
Transplantation of the intestine may be considered for patients with irreversible intestinal failure and preserved liver function.
Liver-intestine transplant
A combined liver and intestinal transplant may be considered when intestinal failure is accompanied by advanced intestinal failure-associated liver disease.
Multivisceral transplant
In selected complex cases, transplantation may include the intestine together with additional abdominal organs.
Refer a patient with complex intestinal failure
AIRI provides multidisciplinary care for patients with intestinal failure, short bowel syndrome, and complex parenteral nutrition needs. We evaluate opportunities for intestinal rehabilitation, manage ongoing nutrition support, monitor for complications, and coordinate specialty or transplant-center evaluation when clinically appropriate.
Hospitals, gastroenterologists, surgeons, LTACHs, and other referring clinicians can contact AIRI to discuss a patient or initiate a referral.
Clinical references
- Kaufman SS, Avitzur Y, Beath SV, et al. New Insights Into the Indications for Intestinal Transplantation: Consensus in the Year 2019. Transplantation. 2020;104(5):937-946.
- Pironi L, Cuerda C, Jeppesen PB, et al. ESPEN guideline on chronic intestinal failure in adults — Update 2023. Clinical Nutrition. 2023.
- Centers for Medicare & Medicaid Services. National Coverage Determination 260.5: Intestinal and Multi-Visceral Transplantation.
This information is intended for clinical and care-coordination purposes and does not replace individualized transplant-center evaluation or current payer medical policy. Transplant candidacy and the appropriate transplant procedure are determined by a specialized transplant center.