Autologous gastrointestinal reconstruction surgery for short bowel syndrome: the cornerstone for intestinal rehabilitation

Frailty as a determinant of liver transplant outcomes: A call for integrative strategies

Frailty has emerged as a pivotal determinant of post-liver transplant (LT) outcomes, yet its integration into clinical practice remains inconsistent. Defined by functional impairments and reduced physiologic reserve, frailty transcends traditional metrics like the model for end-stage liver disease (MELD) score, demonstrating increasing predictive value for mortality beyond the immediate post-operative period. Recent findings suggest that frail recipients experience significantly higher mortality within the first 12 months following transplantation—a period when traditional monitoring often wanes. This raises critical questions about the adequacy of current assessment and follow-up protocols. The observed dissociation between MELD scores and long-term survival underscores the limitations of existing selection criteria. Frailty, as a dynamic and modifiable condition, represents an opportunity for targeted intervention. Prehabilitation programs focusing on nutritional optimization, physical rehabilitation, and psychosocial support could enhance resilience in transplant candidates, reducing their risk profile and improving post-transplant outcomes. Furthermore, these findings call for an expanded approach to post-transplant monitoring. Extending surveillance for frail recipients beyond standard timelines may facilitate early detection of complications, mitigating their impact on survival. Incorporating frailty into both pre- and post-transplant protocols could redefine how transplant centers evaluate and manage risk. This editorial advocates for a paradigm shift: Frailty must no longer be viewed as a secondary consideration but as a core element in LT care. By addressing frailty comprehensively, we can move toward more personalized, effective strategies that improve survival and quality of life for LT recipients.

Current Status of Chronic Intestinal Failure Management in Adults

BACKGROUND

Chronic intestinal failure (CIF) is a heterogeneous disease that affects pediatric and adult populations worldwide and requires complex multidisciplinary management. In recent years, many advances in intravenous supplementation support, surgical techniques, pharmacological management, and intestinal transplants have been published. Based on these advances, international societies have published multiple recommendations and guidelines for the management of these patients. The purpose of this paper is to show the differences that currently exist between the recommendations (ideal life) and the experiences published by different programs around the world.

METHODS

A review of the literature in PubMed from 1980 to 2024 was carried out using the following terms: intestinal failure, CIF, home parenteral nutrition, short bowel syndrome, chronic intestinal pseudo-obstruction, intestinal transplant, enterohormones, and glucagon-like peptide-2.

CONCLUSIONS

There is a difference between what is recommended in the guidelines and consensus and what is applied in real life. Most of the world's countries are not able to offer all of the steps needed to treat this pathology. The development of cooperative networks between countries is necessary to ensure access to comprehensive treatment for most patients on all continents, but especially in low-income countries.

Growing experience of surgical gut rehabilitation: essential role in the management of gut failure in adult patients

PURPOSE OF REVIEW

With the inherent therapeutic limitations of gut transplantation, the concept of surgical gut rehabilitation was introduced to restore nutritional autonomy in pediatric patients. With favorable outcomes in these young patients, there has been increasing interest in the applicability of gut rehabilitative surgery to a growing population of adults with gut failure due to various etiologies. We aim to review the current status of surgical gut rehabilitation for adult gut failure patients in the era of multidisciplinary gut rehabilitation and transplantation.

RECENT FINDINGS

Indications for surgical gut rehabilitation have been gradually expanding, with gut failure after bariatric surgery recently added. Serial transverse enteroplasty (STEP) has been used with favorable outcomes in adult patients, including those with intrinsic intestinal disease. Autologous gut reconstruction (AGR) is the most frequently used surgical rehabilitative method; its outcome is further improved with conjunctive use of bowel lengthening and enterocyte growth factor as a part of comprehensive gut rehabilitation.

SUMMARY

Accumulated experiences have validated the efficacy of gut rehabilitation for survival, nutritional autonomy, and quality of life in adults with gut failure of various etiology. Further progress is expected with growing experience around the world.