US Centers for Medicare and Medicaid Services indications for intestinal transplant
| 1. Failure of parenteral nutrition |
| Impending liver failure (total bilirubin 3–6 mg/dL, progressive thrombocytopenia, progressive splenomegaly) or overt liver failure (portal hypertension, hepatosplenomegaly, hepatic fibrosis, cirrhosis) because of liver injury from parenteral nutrition |
| Central venous catheter-related thrombosis of two central veins |
| Frequent central line sepsis: 2 episodes/year of systemic sepsis secondary to line infections requiring hospitalization; a single episode of line-related fungemia; septic shock or acute respiratory distress syndrome |
| Frequent episodes of severe dehydration despite intravenous fluid in addition to parenteral nutrition |
| 2. High risk of death attributable to underlying disease |
| Desmoid tumors associated with familial adenomatous polyposis |
| Congenital mucosal disorders (eg, microvillus atrophy, intestinal epithelial dysplasia) |
| Ultra-short-bowel syndrome (gastrostomy, duodenostomy, residual small bowel ≤ 10 cm in infants and ≤ 20 cm in adults) |
| 3. Intestinal failure with high morbidity or low acceptance of parenteral nutrition |
| Intestinal failure with high morbidity (frequent hospitalization, narcotic dependency) or inability to function (eg, pseudo-obstruction, high-output stoma) |
| Patient’s unwillingness to accept long-term parenteral nutrition (eg, young patients) |
Adapted from information in reference 50.