Referral for Intestinal Transplantation in the Reference Hospital of Brazil Andre Lee 1 , Flavio Galvão 1 , Mariana Rocha 1 , Igor Calil 1 , Paula Guidi 1 , Natalia Mincheloni 1 , Lidiane Casanova 1 , Maria Dias 1 , Maria Cruz 1 , Wangles Soler 1 , Rafael Pecora 1 , Dan Waitzberg 1 , Luiz D'Albuquerque 1 . 1 Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil Introduction: Since 1991, the Short Bowel Syndrome (SBS) Group from Clinic Hospital of University of São Paulo Medical School (HC-FMUSP) provides gratuity nutritional support for these patients. HC-FMUSP was recently designated by the Brazilian Minister of Health as the reference for intestinal and multivisceral transplantation (IMT) in Brazil. The aim of this study is to analyse the referral for IMT in HC-FMUSP during 2014. Method: Twenty eight patients were referred for IMT to our group receiving home total parenteral nutrition (HTPN). We evaluated their age, gender, main disease, remnant bowel size, complications from SBS, catheter infection, incidence and cause of death and indication for IMT list. The patients we distributed in four subgroups: A: more than 50% jejunum-ileal tract (JIT) resection with ileoceal valve (ICV), B: more than 50% JIT resection without ICV; C: less than 50% JIT resection with ICV; D: less than 50% JIT resection without ICV. Central line infection was detected via paired blood cultures and a culture of the central line tip. Indications for intestinal transplant follow the already establish method. Results: From January to December of 2014, 14 patients (50%) continued exclusively in HTPN and are still referral for IMT and 50% recovered per oral nutrition. Their mean age was 39.79 ± 14.94 years. 60% was male and 40% was female. The main disease were: intestinal pseudobstruction (20%), mesenteric thrombosis (16%), trauma (16%), intestinal malrotation (10%), lymphoma non Hodgkin (10%), colon cancer + mesenteric thrombosis (6%), Appendicitis + peritonitis (10%), Crohn (3%), Gardner syndrome (3%), peritoneal dialysis + peritonitis – 3%, provoked abortion – 3%. All of HTPN dependent became potential referrals for intestinal transplantation. According to bowel length, 15,60% patients were in Subgroup A, 6,40% in B, 28% in C and 50% in D. Complications of HTPN include: infection of catheter (85%), thrombosis of subclavian/julgular vein (65,60%), liver steatosis (38%), cholelithiasis (16%), cholestasis (13%), nephrolothiasis (10%), electrolytes disturbance (22%). The mean of central line infections was 2.00 ± 1,62. According to the patients follow up we observed that 92,9 % were alive and 7,1% died due HTPN complication due sepsis and central line infections. Five patient (17,8 %) were listed for IMT and two of them were submitted to multivisceral transplantation. 180

REFERRAL FOR INTESTINAL TRANSPLANTATION IN THE REFERENCE HOSPITAL OF BRAZIL Andre Lee 1, Flavio Galvão 1, Mariana Rocha 1, Igor Calil 1, Paula Guidi 1,

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Referral for Intestinal Transplantation in the Reference Hospital of Brazil

Andre Lee1, Flavio Galvão1, Mariana Rocha1, Igor Calil1, Paula Guidi1, Natalia Mincheloni1, Lidiane Casanova1, Maria Dias1, Maria Cruz1, Wangles Soler1, Rafael Pecora1, Dan Waitzberg1,

Luiz D'Albuquerque1. 1Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil

Introduction: Since 1991, the Short Bowel Syndrome (SBS) Group from Clinic Hospital of University of São Paulo Medical School (HC-FMUSP) provides gratuity nutritional support for these patients. HC-FMUSP was recently designated by the Brazilian Minister of Health as the reference for intestinal and multivisceral transplantation (IMT) in Brazil. The aim of this study is to analyse the referral for IMT in HC-FMUSP during 2014.

Method: Twenty eight patients were referred for IMT to our group receiving home total parenteral nutrition (HTPN). We evaluated their age, gender, main disease, remnant bowel size, complications from SBS, catheter infection, incidence and cause of death and indication for IMT list. The patients we distributed in four subgroups: A: more than 50% jejunum-ileal tract (JIT) resection with ileoceal valve (ICV), B: more than 50% JIT resection without ICV; C: less than 50% JIT resection with ICV; D: less than 50% JIT resection without ICV. Central line infection was detected via paired blood cultures and a culture of the central line tip. Indications for intestinal transplant follow the already establish method.

Results: From January to December of 2014, 14 patients (50%) continued exclusively in HTPN and are still referral for IMT and 50% recovered per oral nutrition. Their mean age was 39.79 ± 14.94 years. 60% was male and 40% was female. The main disease were: intestinal pseudobstruction (20%), mesenteric thrombosis (16%), trauma (16%), intestinal malrotation (10%), lymphoma non Hodgkin (10%), colon cancer + mesenteric thrombosis (6%), Appendicitis + peritonitis (10%), Crohn (3%), Gardner syndrome (3%), peritoneal dialysis + peritonitis – 3%, provoked abortion – 3%. All of HTPN dependent became potential referrals for intestinal transplantation. According to bowel length, 15,60% patients were in Subgroup A, 6,40% in B, 28% in C and 50% in D. Complications of HTPN include: infection of catheter (85%), thrombosis of subclavian/julgular vein (65,60%), liver steatosis (38%), cholelithiasis (16%), cholestasis (13%), nephrolothiasis (10%), electrolytes disturbance (22%). The mean of central line infections was 2.00 ± 1,62. According to the patients follow up we observed that 92,9 % were alive and 7,1% died due HTPN complication due sepsis and central line infections. Five patient (17,8 %) were listed for IMT and two of them were submitted to multivisceral transplantation.

Conclusion: HTPN improved the survival in SBS if assisted by a qualified multidisciplinary group. The incidence of morbidity-mortality in these patients was high. Intestinal transplantation is the best therapeutic option and can improve the survival and quality of life of these patients, mainly in environments with lack of institutions specialist in HTPN. Early referral for intestinal transplantation, before patient’s condition worsening, may improve the results of this procedure.

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