China
Africa
Explore chapters and articles related to this topic
Intestinal Transplantation for Necrotizing Enterocolitis
Published in David J. Hackam, Necrotizing Enterocolitis, 2021
The primary determiner of the type of intestinal transplant operation (described earlier) is the need for liver replacement and then the extent of bowel (colon) loss from the preexisting NEC. Currently, the most frequently performed operation is an isolated intestine transplant (allograft jejunum and ileum +/– allograft colon) and will be discussed first. For those involved in ITx, the operation itself is relatively straightforward. Once the patient is prepared (discussed under anesthetic considerations), the abdomen is opened. This in itself may be the most difficult part of the operation, especially if there have been extensive adhesions or fistulae. The proximal healthy bowel is identified and isolated, either by taking down a stoma or transection of the anastomosis of the small bowel to small bowel or small bowel to colon. In very high duodenocolonic anastomoses, if it is felt that the old anastomosis cannot be safely taken down and a new one performed to the now even-shorter proximal duodenum, a short segment of the proximal native colon can be left and the allograft intestine then placed between the divided colonic ends. The proximal part of the distal native bowel, either remnant terminal ileum or, more frequently, colon, is also freshened up for eventual anastomosis to the distal intestinal transplant allograft.
Intestinal transplantation
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Intestinal transplantation is now an established treatment modality for intestinal failure. Following animal experiments in the 1960s, notably by Richard C. Lillehei at the University of Minnesota, David Grant in London, Ontario, who performed the first successful liver–intestinal transplant in the late 1980s. Since then, a small but active group of centers has reported increasing experience with the procedure. Deltz reported the first successful long-term small bowel transplant in an adult patient in 1988. Intestinal transplantation is now carried out by itself, i.e. isolated small intestine with or without colon, or as part of a composite graft with various organ combinations, combined liver and intestine, or a multivisceral graft with or without liver. Thus, conceptually it is useful to visualize the intestinal allograft within the context of multi-organ transplantation and to recognize that any allograft which includes the small intestine is defined and considered as an intestine transplant. In recent years, survival following intestinal transplantation has improved so that one-year patient survival at the major, experienced centers has outcomes similar to that of liver transplantation.
Infections in Solid Organ Transplant Recipients Admitted to the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Almudena Burillo, Patricia Muñoz, Emilio Bouza
Infectious enteritis is especially frequent in intestinal transplant recipients (39%). Viral agents are the cause in two-thirds of cases. In a recent series, there were 14 cases of viral enteritis (one of CMV, eight of rotavirus, four of adenovirus, and one of EBV), three bacterial (C. difficile), and three protozoan infections (one Giardia lamblia, two Cryptosporidium spp.). The bacterial infections tended to present earlier than the viral infections; the most frequent presenting symptom was diarrhea [107].
Graft assessment for acute rejection after intestinal transplantation: current status and future perspective
Published in Scandinavian Journal of Gastroenterology, 2021
Intestinal transplantation is defined as a process of grafting an intestinal component (jejunoileum), the development of which was essential to address the issue of intestinal failure and its corresponding complications [1]. Intestinal failure is characterized by an inability of the gastrointestinal tract to meet nutritional demands and thus requiring either temporary or permanent parenteral nutrition to maintain health and/or growth [2]. Most often this condition is caused by short bowel syndrome due to surgical resection, although motility diseases, mucosal defects, obstruction and fistula may also progress to intestinal failure [3]. Overall, the long term survival for patients with non-malignant intestinal failure on PN is excellent (5 year survival 64–91% [4,5]). Therefore, intestinal transplantation is only reserved for patients who have failed parenteral nutrition and developed life-threatening complications [6]. Other indications include lifesaving therapy in portomesenteric thrombosis, frozen abdomen and benign or slow-growing tumour involving the hilum of the liver [7–9]. The three main intestinal transplant procedures that are currently being performed are isolated small bowel, multivisceral (graft including the stomach) and combined liver-intestine grafts. Although, many variations of these procedures exist [1,10].
Advances in non-surgical treatment for pediatric patients with short bowel syndrome
Published in Expert Opinion on Orphan Drugs, 2020
Danielle Wendel, Beatrice E. Ho, Tanyaporn Kaenkumchorn, Simon P. Horslen
Prior to the development of parenteral nutrition (PN) in the 1960s, patients with SBS did not survive [5]. Intestinal transplant became a treatment option in the 1990s for those with life-limiting complications of intestinal failure. Transplant rates peaked in the mid-2000s before decreasing with the rise of multidisciplinary intestinal rehabilitation teams that introduced improvements in medical and surgical management with resulting reductions in morbidity and mortality [6,7]. With the improvements in long-term PN management and prevention of complications of SBS made possible by expert intestinal rehabilitation centers, survival has increased to over 90% [8–10]. Non-surgical management and treatment of SBS involve close monitoring and adjustment of parenteral and enteral intake as well as the prevention and treatment of the many associated complications. There is limited published evidence for many of the treatments in use today due to the small and heterogeneous SBS patient population.
Simultaneous Intestinal and Kidney Transplantation in Adults
Published in Journal of Investigative Surgery, 2019
Irum Amin, Charlotte Rutter, Adam Barlow, Neil K. Russell, J. Andrew Bradley, Andrew Jackson, Andrew J. Butler
Most of the published experience of SIKT relates to recipients who were already on dialysis before transplantation. While the number of patients after SIKT in the present study is inevitably small, given the relative rarity of the procedure, the results compare favourably with the limited published experience. In one of the largest series, Mangus et al. in the USA,3 described the outcome in a series of 76 adult intestinal transplants, that included 17 patients who underwent SIKT. In this series, patient survival at one year was worse in recipients of SIKT, than in recipients of IT alone (40% vs. 72% respectively). In another series of intestinal transplants undertaken for portomesenteric vein thrombosis, Vianna et al.4 described 25 intestinal transplants in 23 patients, nine of whom were already on dialysis at the time of transplantation and had SIKT. In this series, recipients of SIKT showed a non-significant trend towards reduced survival. The recently published Belgian experience13 of IT reported 24 IT in 23 patients, of which five recipients received a simultaneous kidney graft. Three of the recipients were already on dialysis prior to transplantation and the other two had severely reduced eGFRs of 34 and 37 ml/min/1.73 m2. For the series overall, patient survival at one year was 63%, although the survival in the cohort receiving a SIKT was not stated separately.