These are exciting times in intestinal failure management – whether it be as a result of newer lipid emulsions in the management of TPN-associated liver disease (Omegaven, SMOFLipid), or whether it be better understanding of lipid restriction strategies, greater application of intestinal lengthening operations such as STEP and LILT operations and the recent approval of Teduglutide (GLP-2 analog for adult patients with short bowel), outcomes of intestinal rehabilitation appear to be improving. Pari passu with these developments, short and medium-term outcomes for intestinal transplantation are improving, with the larger single centers now routinely reporting patient survivals of between 80 – 90% at 1 year. The growing appreciation of the role of donor-specific antibody (DSA) in intestinal transplantation and strategies to mitigate the effects of DSA, appear to be improving transplant outcomes. There is an expectation that finally we are approaching a time of improving medium and long term outcomes in intestinal transplant.
Recognizing the above, CIRTA2017 will for the first time embrace transplanters and non-transplanters alike, exploring thorny issues toward common cause – improving outcomes for patients with intestinal failure. For the first time, we have a panel of expert invited speakers discussing topics related to non-transplant management of intestinal failure in a state of the art pre-meeting workshop on June 28 – to be capped off with a workshop on the role of DSA in intestinal transplant. For too long, intestinal failure clinicians - non-transplanters and intestinal transplanters - have viewed each other with suspicion amid subtle and not-so-subtle accusations of unnecessary transplants and distressingly late referrals for transplant. We have a unique opportunity to move this orphan field forward; history may well judge CIRTA2017 as the inflexion point when intestinal rehabilitation in general and intestinal transplantation in particular finally came of age.
Welcome to CIRTA 2017 in New York , June 28 – July 1.
Kishore Iyer, MBBS, FRCS (Eng), FACS
Associate Professor of Surgery and Pediatrics
Director, Intestinal Rehabilitation &Transplant Program
Mount Sinai Medical Center