First Reported Case: Full Multivisceral Transplantation as Treatment for Complications of Autoimmune Intestinal Leiomyositis and Autoimmune Hepatitis

may necessitate parenteral nutrition (PN).In light of the recent ESPEN position paper cautioning against PN use in this population (Lal S et al, Clin Nutr 2024), the role of intestinal transplantation (ITx) needs greater clarity.Methods: Retrospective, single-center cohort study of adults with ID or pseudo-obstruction referred for ITX evaluation 2019-2024.Results: Of 13 patients who met criteria, 11 (85%) were female with mean age of 29y (SD 20.6) at onset of ID symptoms and 35.7y (SD 18.4) at referral.All patients had PN dependence > 6 months, with enteral intolerance.Patients were severely malnourished with mean BMI 15.8 kg/m2 at PN initiation.Of 9 patients (9/13, 69%) listed for ITX, 7 received isolated small bowel with colon (1 with pancreas) and 2 remain waitlisted.All listed and post ITX patients had classical indications of CLABSIs including fungemia, sepsis, and endocarditis.Supporting indications included IFALD and poor quality of life.69% (9/13) remained PN dependent including 5 of 7 ITX recipients and 3 of 4 non-ITX patients.Death occurred in 2 patients, including 1 post-ITX (2/13, 15%).Conclusions: Severe ID with failure of enteral nutrition may force the need for PN.Despite following traditional guidelines for ITX, this limited study suggests ITX in this cohort of patients does not confer the same benefit of liberation from PN as seen in other chronic intestinal failure patients.Additional larger studies are urgently needed to clarify the role of ITX.