OBJECTIVE(S): Chronic gut failure(CGF) is associated with life-threatening complications, impaired life-quality, and burdened healthcare-cost. With recent advances in autologous-reconstruction along with visceral transplantation, evidence-based practical guidelines are needed to optimize management and improve value of healthcare.

METHODS: Between August-2012 and January-2018, 275 patients (93%-adults, 67%-female) were evaluated for TPN-dependent CGF. Of these, 203(74%) underwent autologous-reconstruction and 72(26%) received allotransplant. Transplantation was considered for patients with ultra-short gut(<10cm), severe global-dysmotility, diffuse neoplastic syndromes, and liver failure. All patients experienced TPN-associated life-threatening complications with complex-gastrointestinal fistulae in 150(55%). Leading Causes of CGF were surgical(27%), vascular(22%), dysmotility(20%), Crohn's(10%), and neoplastic(9%). Short-gut(<150cm) was documented in 210(76%) patients.

RESULTS: A total of 360 autologous-reconstructions were performed with 1.8 procedure/patient. Of these, 89(25%) were foregut with 16(18%) interposition visceral conduits and 271(75%) were mid-hindgut with 46(17%) intestinal lengthening. Transplant recipients received 79 allografts; 61(77%) liver-free and 18(23%) liver-contained with 10% retransplantation rate. Autologous-reconstruction rescued transplant candidacy with foregut-sparing in 17(24%) recipients and transplantation salvaged 9(4%) autologous-reconstruction patients. With an overall rate of 80%, 5-year patient survival was 86% with autologous-reconstruction and 66% after transplantation. Nutritional autonomy was restored in 197 (83%) survivors with respective 5-year rates of 75% and 89%. Autologous-reconstruction reduced (p<0.05) cost and improved life-quality. Predictors of TPN-free survival after autologous-reconstruction were preserved gut-motility, bowel length(>45cm), retained colon(>50%), intestinal lengthening, reconstructible foregut, and partial TPN-support.

CONCLUSIONS: Autologous gut reconstruction is pivotal to the evolving management armamentarium of chronic gastrointestinal nutritional failure. Re-establishment of native-gut nutritional autonomy restores life-table survival and life-quality with improved healthcare-value.

CITATION INFORMATION: Abu-Elmagd K. M., Armanyous S. R., Parekh N. R., McMichael D., Fujiki M., Hashimoto K., Khanna A., Shatnawei A., Costa G. Gastrointestinal Autologous Reconstruction for Management of Chronic Gut Failure in the New Era of Visceral Transplantation Am J Transplant. 2017;17 (suppl 3).

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