NPS Pharmaceuticals Member of scientific steering committee Coram Home Care Advisory board member
Lauren K. Schwartz, MD Concorde Medical Group June 12, 2015
Overview
Short Bowel Syndrome
Overview of SBS Normal gut physiology Short bowel pathophysiology Intestinal rehabilitation Evaluation for therapeutic planning Traditional interventions New trophic therapy Intestinal transplant Indications, Operations, Expectations
Malabsorptive condition caused by loss of an extensive
length of small intestine 10% higher than baseline Jeppesen PB, et al. Gastroenterology 2012;43:1473-81
Response is defined as 20–100% Reduction in weekly PN/IV volume at weeks 20 & 24 Jeppesen PB, et al. Gastroenterology 2001;43: 1473-81
STEPS: Mean Reduction in PN Volume Mean change in PS volume (L/week)
Week ‐0.5 ‐1.0 ‐1.5 ‐1.1
‐1.9
‐2.1
‐2.3
‐2.0* Difference 2.1 L/week
‐2.9** ‐3.4*** ‐3.8***
‐4.4***
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Intestinal Transplant: History
Intestinal Transplant: Indications Irreversible intestinal failure with TPN dependence
1960’s
1970s
1980’s
1990’s
2000’s
PLUS TPN failure* Blood stream infections
ITx first attempted
CSA (’78)
Deaths due to technical complications, rejection, infection
1st successful ITx
1988: Grant et al. adult combined liver/SB tx
Tacrolimus (’90)
# of ITx
Growth in # of transplants
Impending or overt liver failure Thrombosis of ≥2 central veins
US 3/2013 2,287 Itx CMS recognizes ITx 2000
Liver dysfunction Loss of vascular access
≥2 line sepsis w/ hospitalization in a yr 1 fungemia 1 line sepsis with shock or ARDS Metastatic infection
Recurrent dehydration despite TPN/IVF
* As defined by Center for Medicare and Medicaid Services
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Intestinal Transplant: Timing Is there a role for pre‐emptive intestinal transplant?
