As part of the on-going collaboration between TTS and our official Sections, and in order to provide TTS members with an update on areas of the field represented by TTS Sections, content for this issue of the Pulse has been submitted by the International Intestinal Rehabilitation & Transplant Association.

Special IIRTA Feature

The Intestinal Transplant Association (ITA) was born in 2003 reflecting the joint vision of the late Richard Wood and Kareem Abu-Elmagd at the VIth International Small Bowel Transplant Symposium in 1999. The participants in the VIIIth International Small Bowel Transplantation Symposium held in Miami in 2003, unanimously voted to establish the Intestinal Transplant Association (ITA) as a formalized and unified group of professionals with a common interest in intestinal failure, intestinal rehabilitation, and intestinal transplantation.

This proposal was later put forth before the Council of The Transplantation Society (TTS) who accepted the ITA as a Section within The Transplantation Society. The formal name of the society has changed over the years as the fields of intestinal failure and transplant have evolved and the international nature of the society has been recognized.

Through the leadership of the multidisciplinary elected council, the IIRTA seeks to promote medical and surgical advances and research to optimize the lives of all patients with intestinal failure. Dedicated committees oversee membership, scientific activities, educational events and communications.

Our Vision

  • To ensure excellent physical and emotional health for all people with intestinal failure through rehabilitation and transplantation.

Our Missions

  • To optimize the lives of intestinal failure patients worldwide through innovative nutritional, medical, psychosocial, surgical and transplant research and therapies.
  • To maintain global leadership through a multidisciplinary approach to intestinal failure, rehabilitation and transplantation.
  • And to advance the support for all professionals working in the field of intestinal transplantation and rehabilitation with regard to education, policy, research and advocacy.

Our Values

  • Excellence: Promoting innovative clinical, basic and translational science through multidisciplinary teamwork.
  • Collaboration: Working closely with patients, IIRTA members, scientific societies, health organizations, and governments.
  • Advocacy: supporting the patient’s voice in speaking as a unified influence in issues of concern to the IF and Intestinal transplant community.
  • Integrity: Acting on the highest standards of ethical practice.

Our Goals

  • Enhance communication and organizational effectiveness by using the TTS administrative support to hold quarterly Council meetings and organize biennial symposiums, periodic newsletters, and other scientific activities.
  • Create a community of practice through the development of clinical practical guidelines and educational materials.
  • Facilitate research by creating a repository of information and fostering proposals to enhance the scientific and academic mission of the Intestinal Transplant Registry (ITR).
  • Increase membership by outreach to other relevant scientific communities including gastrointestinal associations, transplant societies, and other allied health and patient advocacy organizations.

Chapters

The establishment of national or regional Chapters has fostered reciprocal relationships, where Chapter members would engage in IIRTA activities, and in return, the association would provide support for local clinical, educational, or research meetings and initiatives

VISIT THE IIRTA CHAPTERS PAGE

Developments

The introduction of comprehensive Intestinal Rehabilitation Programmes in specialist centres has undoubtedly improved outcomes for patients and likely explains some of the recent drops in ITx activity, at least in children. Glucagon-like Peptide-2 analogues have provided the first pharmacological advancement to improve the quality of life and reduce morbidity for patients living with Intestinal Failure. Insights into the immunological mechanisms for host and graft responses and genetic risk factors for graft rejection (eg NOD2), coupled with proactive monitoring for medical complications and surgical advances, have contributed to ever-improving outcomes after transplantation.

International Registries

The International Intestinal Failure and Intestinal Transplant Registries directed by Yaron Avitzur and Rob Venick respectively continue to grow and provide much-needed collaborative epidemiological and outcome data for these rare conditions.

Visit the Intestinal Transplant Registry Page

Visit the Intestinal Failure Registry Page

Webinars

Our Allied Health Committee organized several successful webinars over the past year, including a ‘Research 101’ session which discussed the principles of research methodology and provided practical tips for abstract submission, just in time for the CIIRTA 2025 Congress!

Visit the IIRTA Webinar Page

Recent Webinar Presentations

Intestinal Failure - The Official Journal IIRTA

VIEW JOURNAL DETAILS

Intestinal Failure, the official journal of the IIRTA, launched in early 2024 under the leadership of Doug Farmer, from UCLA, as Editor-In-Chief; and Helen Evans, from Starship Children’s Health NZ, as Deputy Editor. This open-access journal aims to be the leading publication in the fields of intestinal failure, intestinal rehabilitation and intestinal/multivisceral transplantation. It is truly multidisciplinary and bridges basic science and clinical research. A special issue from the PIFRS meeting in Pittsburgh will be followed by a second special issue from CIIRTA 2025. So far articles published originate from 8 different countries across adults and paediatrics and encompassing all aspects of intestinal rehabilitation.

Most Downloaded Article

Anticoagulation and antiplatelet therapy in short bowel syndrome: A systematic review
Carolyn Mercer, Anna Crawford, Susan Shapiro, Philip J Allan, Tim Ambrose.
Intestinal Failure, Volume 1, 100007

Editor's Highlighted Article

Outcomes after intestinal re-transplant: A detailed, single-center analysis of clinical and technical factors
Carolyn P. Smullin, Robert S. Venick, Suzanne V. McDiarmid, Ronald W. Busuttil, Douglas G. Farmer

Read EDITOR's COMMENT

CIIRTA 2025

Our biennial congress CIIRTA2025 is being held on 10-13th September in the beautiful Swedish city of Gothenburg, jointly hosted by Sahlgrenska University Hospital Gothenburg and Karolinska University Hospital Stockholm. The theme of Searching for The ‘True North’ reflects the geographical location of Gothenburg at 57.7degrees North and the continued work of the Intestinal Rehabilitation community to optimize care and outcomes for patients suffering with Intestinal Failure.

Keynote lecturers

George Mazariegos
USA
Loris Pironi
Italy
Girish Gupte
USA

Follow the IIRTA and CIIRTA2025 on Social Media!

Recent Intestinal Transplant Publications in the Transplantation Journal

Endoscopic Surveillance of the Intestinal Allograft: Recommendations From the Intestinal Rehabilitation and Transplant Association

Garcia, Jennifer et al.
Transplantation 108(4):p 827-835, April 2024. | DOI: 10.1097/TP.0000000000004785
Endoscopic monitoring of the intestinal graft is a key part of patient follow up, as the rates of acute cellular rejection remain high (30-50% in the first year in various series) and there is no reliable biomarker of intestinal graft rejection. Due to a lack of previous consensus or guidance, wide variations in practice have been seen. A working group was convened in 2019 of 17 experts in the field resulting in various recommendations regarding endoscopic surveillance which are contained in this report.

Precision Delivery of Therapeutics to the Intestine: A Case Series of Superselective Steroid Administration in Pediatric Intestinal Transplant Recipients

Levitte, Steven et al.
Transplantation108(8):p e202-e203, August 2024. | DOI: 10.1097/TP.0000000000005053
Here the team from Stanford discuss their use of targeted intra-arterial steroid treatment for focal graft inflammation in two pediatric intestinal transplant recipients, with full recovery documented. This technique may have wider implications beyond the transplant community, for example in inflammatory bowel disease, ischaemic drug-induced intestinal lesions and may avoid systemic toxicity from corticosteroids or biologics for some patients.

Current Advances in Graft-versus-host Disease After Intestinal Transplantation

Oza K, et al.
Transplantation 2024 Feb 1;108(2):399-408. doi: 10.1097/TP.0000000000004703
Graft versus host disease is one of the most feared complications after Intestinal and Multivisceral Transplantation, occurring in 5-10% of patients with published mortality rates of 77% The balance of host and graft responses and the clinical importance of micro- and macro-chimerism are becoming increasingly understood in this patient population. Recent small studies have demonstrated macrochimerism in patients without the development of clinical GVHD, perhaps approaching the desired state of operational tolerance which would allow withdrawal or at least a significant reduction of immunosuppression. Current treatment of GVHD however, still extrapolates significantly from GVH after other solid organ or haematopoietic stem cell transplantation due to the paucity of data and lack of controlled trials in ITX recipients. Oza et al nicely summarise the existing literature regarding the diagnosis and treatment of GVHD after ITx in this report.

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