Adult Intestinal and Multivisceral Transplantation: Experience From a Single Center in the United Kingdom

Rutter, Charlotte; Amin, Irum; Russell, Neil; Sharkey, Lisa; Butler, Andrew; Middleton, Stephen

doi:10.1016/j.transproceed.2015.10.079

Cited by 17 publications

(10 citation statements)

References 6 publications

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“…Patients with chronic intestinal failure depend on parenteral nutrition (PN) to maintain health and preserve life. While there have been advances in intestinal transplantation, 1 , 2 interesting developments in intestinal lengthening, 3 and the novel application of growth factors, 4 home PN (HPN) is likely to remain the mainstay treatment for most patients in the medium term 5 . Dedicated venous catheters managed with rigorous aseptic protocols are vital in preventing complications and obtaining good long‐term outcomes in patients receiving HPN.…”

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confidence: 99%

Home Parenteral Nutrition: Vascular Access and Related Complications

Dibb

Lal

2017

Nut in Clin Prac

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Patients with chronic intestinal failure are dependent on parenteral nutrition (PN) to maintain health and preserve life. Maintaining safe vascular access is vital to prevent life-threatening complications such as catheter-related bloodstream infection or central venous occlusion. Dedicated central venous catheters with rigorous catheter care aseptic protocols are vital in obtaining good long-term outcomes that allow continuation of PN over many years. Good catheter care requires an experienced multidisciplinary team using appropriate vascular devices, trained to identify and aggressively treat catheter-related bloodstream infections, catheter occlusions, and catheter-related thrombosis. Consideration must also be given to evolving strategies to prevent recurrent infections, including prophylactic central venous catheter locks.

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confidence: 99%

Home Parenteral Nutrition: Vascular Access and Related Complications

Dibb

Lal

2017

Nut in Clin Prac

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“…23,24 The doses of alemtuzumab used in transplant (30 mg at induction with another 30 mg sometimes given at day +1) and multiple sclerosis are comparable. 8 In our series multiple therapies for immune cytopenias were utilised; median four (range 1-8) and 5/6 were managed with rituximab.…”

Section: Discussionmentioning

confidence: 91%

Transplant‐associated thrombotic microangiopathy and immune haematological complications following intestine‐containing organ transplantation: experience from over 100 consecutive cases

et al. 2021

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Descriptions of passenger lymphocyte syndrome (PLS), immune cytopenias and transplant-associated thrombotic microangiopathy (TA-TMA) after intestine-containing transplants remain scarce. We describe our centre's experience of these complications from 2007 to 2019. Ninety-six patients received 103 transplants. PLS occurred in 9 (9%) patients (median 12 days post-transplant); all due to ABO antibodies. There were 31 minor ABO mismatch transplants. No patient required change in immunosuppression. Immune cytopenias (excluding PLS) occurred in six patients at an incidence of 1Á7/100 patient years; three immune haemolysis, one immune thrombocytopenia, one acquired Glanzmann's and one immune neutropenia; 50% occurred with other cytopenias. All cases eventually responded to treatment, with a median of four treatments (range 1-8) and 5/6 were treated with rituximab. One patient with immune haemolysis required bortezomib. Complications were common in patients with immune cytopenias; 4/6 with infection needing intravenous antibiotics and 3/6 with venous thromboembolism. In 3/6 cases, a secondary cause for the immune cytopenia was evident. Switching from tacrolimus to ciclosporin was not necessary. There were five cases of transplant-associated thrombotic microangiopathy (TA-TMA; 1Á5/100 patient years) requiring calcineurin inhibitor withdrawal; two cases associated with acute rejection. Two cases were managed with plasma exchange, one with plasma infusions and one with eculizumab. Further research in this patient group is required.

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“…Thus, from the clinical standpoint, it is not surprising when more ICT/PE events occur with MVTx than with OLT, isolated intestine transplant, or modified MVT. Another large center is reporting similar issues, as well, although without much details . Routine use of TEE and heightened awareness for ICT/PE during haemodynamic instability and hemorrhage have likely enabled us to more precisely detect the occurrence of this complication.…”

Section: Discussionmentioning

confidence: 98%

“…Rutter et al . 's study reported a 29% 1‐year mortality in MVTx recipients, with on‐table bleeding responsible for 14% of mortality, and that thrombosis was among the other causes of early mortality. Older studies have suggested that disseminated intravascular coagulation (DIC) during orthotopic liver transplantation (OLT) is rare .…”

Section: Introductionmentioning

confidence: 99%

“…Despite current advancements in survival, when MVTx is performed in patients with extensive portal mesenteric thrombosis (PVT), it remains a surgical challenge that carries high risk of bleeding [4]. Rutter et al's [5] study reported a 29% 1-year mortality in MVTx recipients, with on-table bleeding responsible for 14% of mortality, and that thrombosis was among the other causes of early mortality. Older studies have suggested that disseminated intravascular coagulation (DIC) during orthotopic liver transplantation (OLT) is rare [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

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Thrombotic and hemorrhagic complications during visceral transplantation: risk factors, and association with intraoperative disseminated intravascular coagulation-like thromboelastographic qualities: a single-center retrospective study

et al. 2018

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This study describes the risk of thrombotic and hemorrhagic complications, both intraoperatively, and up to 1 month following visceral transplantation. Data from 48 adult visceral transplants performed between 2010 and 2017 were retrospectively studied [32 multivisceral (MVTx); 10 isolated intestine; six modified-MVTx]. Intraoperatively, intracardiac thrombosis (ICT)/pulmonary embolism (PE) occurred in 25%, 0% and 0% of MVTx, isolated intestine and modified MVTx, respectively, and was associated with 50% (4/8) mortality. Preoperative portal vein thrombosis (PVT) was a significant risk factor for ICT/PE (P = 0.0073). Thromboelastography resembling disseminated intravascular coagulation (DIC) (r time <4 mm combined with fibrinolysis or flat-line) was statistically associated with occurrence of ICT/PE (P < 0.0001). Compared to subgroup without ICT/PE, occurrence of ICT/PE was associated with an increased demand for all blood product components both overall, and each surgical stage. Hyperfibrinolysis (56%) was identified as cause of bleeding in MVTx. Incidence of postoperative thrombotic event at 1 month was 25%, 30% and 17% for MVTx, isolated intestine and modified MVTx, respectively. Incidence of postoperative bleeding complications at 1 month was 11%, 20% and 17% for MVTx, isolated intestine and modified MVTx. In conclusion, MVTx recipients with preoperative PVT are at an increased risk of developing intraoperative life-threatening ICT/PE events associated with DIC-like coagulopathy.

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Adult Intestinal and Multivisceral Transplantation: Experience From a Single Center in the United Kingdom

Cited by 17 publications

References 6 publications

Home Parenteral Nutrition: Vascular Access and Related Complications

Home Parenteral Nutrition: Vascular Access and Related Complications

Transplant‐associated thrombotic microangiopathy and immune haematological complications following intestine‐containing organ transplantation: experience from over 100 consecutive cases

Thrombotic and hemorrhagic complications during visceral transplantation: risk factors, and association with intraoperative disseminated intravascular coagulation-like thromboelastographic qualities: a single-center retrospective study

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