Proposed model for a Small Bowel Transplantation Program in Brazil

Abstract

Objective: The amount of transplantation centers performing intestinal transplants have increased in the last few years. Over the past decade, small bowel transplantation (SBT) has developed from an experimental procedure to a life-saving therapy. Herein, it will be described the present policy proposed to the Brazilian Health Ministry, in order to start-up a intestinal transplant program in Brazil. Methods: SBT is indicated for adult and pediatric patients with short bowel syndrome and those dependent to Prolonged Parenteral Nutrition (PPN), irreversible intestinal failure, pseudoobstruction, microvilous disease or benign abdominal tumors with involvement of the small bowel. The list criteria include patients with remaining small bowel less/equal to 40 cm measured at the resection time; loss of a venous access; no possibility to resume oral intake without PPN support; one episode of catheter-related sepsis and PPN-related liver dysfunction. Loss of all venous accesses, uncontrolled infections, malignant tumors with less than 5 years follow-up and no-treated cardiovascular/lung diseases were the excluding criteria. A first step may only certify a lower amount of reference centers all over the country, aiming to better develop the expertise. Conclusion: It was concluded that factors related to a successful procedure, such as advancements in the surgical technique and the selection of patients on lists must significantly contribute to the improvement of outcomes.