A person who is receiving total parenteral nutrition (TPN) for short bowel syndrome or other intestinal disorder may be a candidate for liver transplantation if there evidence for impending failure. Certain findings are used by Medicare to determine if a small intestinal transplant is appropriate for such a patient.


Patients selection: long-term total parenteral nutrition for significant bowel disease


Conditions which may justify small intestinal transplantation:

(1) impending or overt liver failure secondary to TPN

(1a) cholestatic syndrome

(1b) cirrhosis or severe hepatic fibrosis

(1c) complication of cirrhosis (thrombocytopenia, bleeding varices, splenomegaly)

(2) >= 2 thrombosis in major veins used for vascular access

(3) serious infections associated with central vascular access

(3a) >= 2 episodes per year of sepsis associated with central line infections

(3b) >=1 episode of line-associated fungemia

(3c) >= 1 episode of septic shock and/or ARDS

(4) frequent episodes of severe dehydration despite intravenous fluid administration



• The presence of frequent thromboses may indicated a hypercoagulable state.


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