Adult Intestinal Transplantation

Matsumoto, Cal; Subramanian, Sukanya; Fishbein, Thomas M.

doi:10.1016/j.gtc.2018.01.011

Cited by 45 publications

(35 citation statements)

References 23 publications

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“…34 This change has mainly been a result of a precipitous decrease in the number of pediatric visceral transplantations due to improved specialized care for pediatric gut failure. 7 Although the number of adult intestine transplants has remained relatively steady in the past decade, ranging from 77 to 92/y, the total number of visceral transplantation is far smaller than those of other abdominal organs.…”

Section: The Current Challenges and Future Perspective In Visceral Trmentioning

confidence: 99%

“…According to recent registry data, approximately 15% of all adult and 1% of pediatric intestinal transplants were performed for neoplasms. 7 Despite recent improvements in postoperative management of these patients, the main obstacle toward the use of visceral allografts for malignancy continues to be the need for stronger immunosuppression that greatly suppresses innate and adaptive tumor immunity. To eliminate such unfavorable effects of immunosuppression, autotransplantation has emerged as a favored alternative to visceral allotransplantation, 8,9 as the former approach does not require immunosuppression.…”

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confidence: 99%

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The Role of Visceral Transplantation for Neoplastic Disease

Fujiki

Nair

D’Amico

et al. 2020

Digestive Disease Interventions

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Visceral transplantation has been utilized as the most radical surgical treatment for neoplasms not amenable to conventional resection. The main indications for this procedure include mesenteric desmoid tumors threatening the root of mesentery and metastatic neuroendocrine neoplasms. Published case-series of visceral transplantation for such indications are reviewed in this article. Patients with desmoid tumors associated with familial adenomatous polyposis are transplanted with intestinal or multivisceral allografts. With surgical modification of technique, the native spleen is preserved while duodenopancreatic complex is removed to obviate the risk of malignant transformation of duodenal polyposis after transplantation. Preservation of spleen decreased incidence of post-transplant lymphoproliferative disorder, conferring therapeutic advantage. Patient survival is comparable to that of other indications, and desmoid tumor recurrence has been observed in the recipient tissue but not in the donor allograft. For visceral transplantation of metastatic neuroendocrine neoplasms, the majority of these patients have diffuse liver involvement, thus requiring full multivisceral transplantation. Post-transplant patient survival is acceptable with limited data available on recurrence. Autotransplantation following ex vivo tumor resection using visceral allografts has been also performed in a limited, select cohort of patients with various pathologies. Adenocarcinomas are associated with a prohibitive recurrence rate following the procedure, and its use for this indication is therefore not recommended. A national database of visceral transplantation undertaken for neoplastic disease should be developed to better understand predictors of outcomes and to help produce and standardize selection criteria.

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Section: The Current Challenges and Future Perspective In Visceral Trmentioning

confidence: 99%

mentioning

confidence: 99%

The Role of Visceral Transplantation for Neoplastic Disease

Fujiki

Nair

D’Amico

et al. 2020

Digestive Disease Interventions

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“…Innovative cross match strategies and optimizing organ allocation could improve the long-term outcome, but the main causes of death and graft loss remain sepsis and rejection. Challenges for long-term results are chronic rejection and immunosuppressant-related complications[ 46 , 47 ]. According to Intestinal Transplant Registry reports[ 44 ], 1611 children were transplanted worldwide between 1985 and 2013, with an overall patient survival rate of 51%.…”

Section: Surgeon’s Perspectivementioning

confidence: 99%

“…In the 2014-2016 Scientific Registry of Transplant Recipients[ 48 ], the 6 American centers that in 2016 performed 10 or more intestinal transplants in adults reported a 1-year graft survival from 61% to 83% and a 3-year graft survival from 29% to 73%. In an earlier report from 2008 to 2010, the 1-year graft survival in adults was 71%, illustrating the relatively modest gains achieved[ 47 ]. Intestinal transplantation should be suggested to a very select subset of SBS patients with severe and irreversible complications of PN and no hope of intestinal rehabilitation.…”

Section: Surgeon’s Perspectivementioning

confidence: 99%

Surgeon’s perspective on short bowel syndrome: Where are we?

Marino¹,

Lauro²

2018

WJT

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Short bowel syndrome (SBS) is due to a massive loss of small bowel: the reduction of gut function is below the minimum necessary to maintain health (in adults) and growth (in children) so intravenous supplementation is required. Parenteral nutrition represents the milestone of treatment and surgical attempts should be limited only when the residual bowel is sufficient to increase absorption, reducing diarrhea and slowing the transit time of nutrients, water and electrolytes. The surgical techniques lengthen the bowel (tapering it) or reverse a segment of it: developed in children, nowadays are popular also among adults. The issue is mainly represented by the residual length of the small bowel where ileum has shown increased adaptive function than jejunum, but colon should be considered because of its importance in the digestive process. These concepts have been translated also in intestinal transplantation, where a colonic graft is nowadays widely used and the terminal ileum is the selected segment for a living-related donation. The whole replacement by a bowel or multivisceral transplant is still affected by poor long term outcome and must be reserved to a select population of SBS patients, affected by intestinal failure associated with irreversible complications of parenteral nutrition.

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“…Intestinal transplantation is indicated in patients with irreversible intestinal failure and associated life-threatening complications [1,2]. While the procedure has increased in frequency in recent decades (five performed in the United States in 1990 to 146 in 2016), survival rates for these procedures have not changed for the last decade [1,3]. Complications affecting survival rate include graft rejection, infection, and reduced ability to reabsorb fluids and electrolytes leading to dehydration [4,5].…”

Section: Introductionmentioning

confidence: 99%

Including colon in intestinal transplantation: a focus on post‐transplant renal function – a retrospective study

et al. 2019

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Summary Intestinal transplant recipients experience a high rate of renal complications secondary to dehydration due to increased ostomy output. It is hypothesized that inclusion of donor colon in the intestinal allograft may improve renal function in patients without functional native colon by improving fluid absorption. A single‐center retrospective study of intestinal transplant recipients compared outcomes of patients receiving en bloc colon as part an intestinal allograft (ICTx), and those not receiving colon (CCNTx), as well as a control group of intestinal transplant recipients with functional native colon (ITx). Forty‐seven patients (ICTx n = 17, CCNTx n = 15, ITx n = 15) were studied. One‐year post‐transplant renal function, as measured by change in glomerular filtration rate (GFR) and blood urea nitrogen (BUN) from baseline, was superior in ICTx (mean delta‐GFR of −1.31 and delta‐BUN of −1.46) compared to CCNTx (−6.54 and 17.54, P = 0.05 and P = 0.17, respectively) and similar to the ITx controls (0.55 and 2.09). Recipients of donor colon experienced a higher rate of ileostomy reversal when compared to CCNTx (62.5% vs. 20%, P = 0.0008), which was similar to the ITx controls (60%). These findings support the inclusion of en bloc donor colon in the intestinal allograft for recipients without functional native colon.

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Adult Intestinal Transplantation

Cited by 45 publications

References 23 publications

The Role of Visceral Transplantation for Neoplastic Disease

The Role of Visceral Transplantation for Neoplastic Disease

Surgeon’s perspective on short bowel syndrome: Where are we?

Including colon in intestinal transplantation: a focus on post‐transplant renal function – a retrospective study

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