The article by Gerlach et al1 published in this issue of JAMA Surgery has the promise to usher in an era in which the time to cease traditional medical and surgical therapies and initiate transplantation care is defined. The role of intestinal transplantation, although proven to be of value in many patients with intestinal failure, has not been identified in patients with Crohn disease. Unlike many diseases that lead to intestinal failure and transplantation in which there are few additional medical or surgical options, Crohn disease has a broad armamentarium of treatment options, although some of these treatments may complicate or ultimately contraindicate intestinal transplantation. The current state of intestinal transplantation is at the same phase as liver transplantation for biliary atresia was in 1988 and defining the risk-benefit ratio in liver transplantation with MELD.2,3 The question for patients with biliary atresia was whether a portoenterostomy was indicated and, if so, whether patients should continue with surgical revision or proceed with liver transplantation. Similarly, patients with Crohn disease have many surgical and medical options that markedly complicate the analysis of the decision algorithm.
J. Michael Millis. Crohn Disease and Intestinal TransplantationBenefit Balance. JAMA Surg. 2014;149(10):1067. doi:10.1001/jamasurg.2014.1804