Advances in small bowel transplantation

Abstract

135Small bowel transplantation is a life-saving surgery for patients with intestinal failure. The biggest problem in intestinal transplantation is graft rejection. Graft rejection is the main reason for morbidity and mortality. Rejection has a negative effect on the survival of the graft. While 50%-75% of small bowel transplantation patients experience acute rejection, chronic rejection occurs in approximately 15% of patients. Immune monitoring is crucial after small bowel transplantation. Unlike other types of transplantation, there are no non-invasive or reliable markers to predict rejection in small bowel transplantation. The diagnosis of AR is confirmed by clinical symptoms, endoscopic appearance, and pathological specimens taken by endoscopy. Thus, histopathological examinations obtained by protocol biopsies remain as the gold standard for intestinal graft monitoring; however, biopsies have some complications, especially in small grafts. In addition to the high complication rate, biopsies are non-diagnostic; thus, multiple biopsies should be performed to exclude rejection. Therefore, auxiliary assays, such as measurements of citrulline and calprotectin in the blood, cytofluorographic examination of peripheral blood immune cells, cytokine profiling, and distinct gene-set-change measurements, are increasingly being used in small bowel transplantation. Developments in the understanding of genes seem to be promising that limited gene sets, taken from blood or from intestinal biopsies, will enhance pathological diagnosis. Bone marrow mesenchymal stem cell transplantation with SBT and tissue engineering are also promising procedures.

Luminal preloading with hydrogen‐rich saline ameliorates ischemia‐reperfusion injury following intestinal transplantation in rats

“…Intestinal IR injury, obligatory to the consequences of cold preservation and transplantation of the intestinal grafts, can result in early graft failure and life-threatening events for recipients. [1][2][3] Advanced IR injury and subsequent mucosal barrier damage can cause considerable bacterial translocation and systemic inflammation, as well as fluid and electrolyte shifts. 4 Hydrogen gas, a stable molecule that may have oxidant or reductive characteristics depending upon the environment in which it is placed, has been applied in several experimental models in the organ transplantation field.…”

The effect of perioperative electrolyte, acid-base balance, hemodynamic data and anesthetic management on early mortality of patients with small bowel transplantation

“…In case of tissue rejection due to ischemia reperfusion injury, overall mortality and morbidity rate was reported as 50-75% of acute rejection and 15% of chronic rejection (12) . Chronic rejection was detected in our 3 cases whom we monitored respectively.…”

Surgical Treatment of Short Bowel Syndrome—The Past, the Present and the Future, a Descriptive Review of the Literature

“…ESPEN lists the following: impending, progressive or overt liver failure due to intestinal-failure-associated liver disease (IFALD); thrombosis of two or more major venous vessels; two or more central line infections per year with sepsis; refractory electrolyte changes and frequent episodes of dehydration; high risk of death attributable to underlying disease such as congenital mucosal disorders; ultra-short bowel syndrome (gastrostomy, duodenostomy, residual small bowel <10 cm in infants and <20 cm in adults) and invasive intra-abdominal desmoid tumors; patients with high morbidity (frequent hospitalization, narcotic dependency, inability to function (i.e., pseudo-obstruction, high output stoma) or low acceptance of long-term PN, especially in young patients [ 74 ]. Furthermore, it has been stated that patients should be considered for IT with loss of venous access, sepsis secondary to infected thrombi, pulmonary embolism and alterations of growth and development in children [ 184 , 185 ].…”