Clinical Intestinal Transplantation: A Decade of Experience at a Single Center

Abu‐Elmagd, Kareem; Reyes, Jorge; Bond, Geoffrey; Mazariegos, George; Wu, Tong; Murase, Noriko; Sindhi, Rakesh; Martin, Dolly; Colangelo, J; Zak, Marsha; Janson, Douglas; Ezzelarab, Mohamed; Dvorchik, Igor; Parizhskaya, Maria; Deutsch, Melvin; Demetris, Anthony J.; Fung, John J.; Starzl, Thomas E.

doi:10.1097/00000658-200109000-00014

Cited by 349 publications

(264 citation statements)

References 39 publications

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“…Nine allografts, including the two that consisted of multiple organs, had ex-vivo bowel irradiation (7·5 Gy). Recipients of these nine grafts were given an infusion of 2·4-9·0 × 10 8 / kg donor bone marrow cells within the subsequent 24 h. 10 The two recipients of nonirradiated intestine were not given adjunct bone marrow.…”

Section: Intestine Transplantationmentioning

confidence: 99%

Tolerogenic immunosuppression for organ transplantation

et al. 2003

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SummaryBackground-Insight into the mechanisms of organ engraftment and acquired tolerance has made it possible to facilitate these mechanisms, by tailoring the timing and dosage of immunosuppression in accordance with two therapeutic principles: recipient pretreatment, and minimum use of post-transplant immunosuppression. We aimed to apply these principles in recipients of renal and extrarenal organ transplants.

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Section: Intestine Transplantationmentioning

confidence: 99%

Tolerogenic immunosuppression for organ transplantation

et al. 2003

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“…Human small-bowel transplantation has become a mainstay for the treatment of intestinal failure (1)(2)(3), particularly in the situation where extended usage of total parenteral nutrition (TPN) has caused significant morbidity in the patient. The success of bowel transplantation has markedly improved with the employment of modified immunosuppressive protocols that have included reagents such as tacrolimus, and re-43 fined surgical techniques (2,3).…”

Section: Introductionmentioning

confidence: 99%

“…The success of bowel transplantation has markedly improved with the employment of modified immunosuppressive protocols that have included reagents such as tacrolimus, and re-43 fined surgical techniques (2,3). However, several factors remain as significant impediments to optimal graft survival.…”

Section: Introductionmentioning

confidence: 99%

Mucosal Vascular Alterations in Isolated Small‐Bowel Allografts: Relationship to Humoral Sensitization

Ruiz

Garcia²,

Pappas

et al. 2003

American Journal of Transplantation

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Acute vascular rejection (AVR) in human small-bowel transplantation is an inadequately characterized entity whose frequency and severity is not well understood. As compared to severe AVR, changes identifying early, mild or evolving AVR are not known. We created a scoring system to evaluate subtle mucosal vascular changes and examined 188 biopsies from 21 patients obtained in the first 3 months post transplant. A majority of patients had a transient rise in vascular injury, often within 30 days of transplant. Small-vessel congestion and erythrocyte extravasation were the most common alterations. The vascular injury score was not related to acute cellular rejection, HLA type or HLA antigen disparities. However, the patients with the vascular changes had significantly higher peak panel reactive antibodies (PRA) and a higher incidence of positive T-cell and B-cell crossmatch. Finally, graft survival was significantly lower in the patients demonstrating the early vascular lesions. These data suggest that the vascular injury is partially associated with humoral presensitization of the recipient and may be a form of acute vascular rejection. Since these vascular changes are frequent, we advocate early post-transplant monitoring to identify and manage potentially high-risk patients.

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“…(Liver Transpl 2003;9:881-886. )I mproved outcomes after multivisceral and isolated intestinal transplantation [1][2][3][4][5][6] have renewed interest in these techniques as evidenced by United Network for Organ Sharing (UNOS) data showing annual increases in isolated intestinal and multivisceral transplantation since 1998. 7 In an era of limited cadaver-donor supply, enhanced recognition of potential multivisceral/intestinal cadaver-donors is necessary.…”

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Multivisceral and isolated intestinal procurement techniques

Yersiz¹

2003

Liver Transplantation

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Improved outcomes in multivisceral and isolated intestinal transplantation have generated increased demand for these procedures. Enhanced recognition of potential multivisceral/intestinal donors and widespread application of advanced organ procurement techniques is necessary in the current climate of organ scarcity. This manuscript details the multivisceral and isolated intestinal procurement techniques currently performed at the University of California Los Angeles. (Liver Transpl 2003;9:881-886.)I mproved outcomes after multivisceral and isolated intestinal transplantation [1][2][3][4][5][6] have renewed interest in these techniques as evidenced by United Network for Organ Sharing (UNOS) data showing annual increases in isolated intestinal and multivisceral transplantation since 1998. 7 In an era of limited cadaver-donor supply, enhanced recognition of potential multivisceral/intestinal cadaver-donors is necessary. This article details the techniques applied by our donor recovery team in performing multivisceral and isolated intestinal procurements.The procurement techniques herein are a modification of the original descriptions of Starzl et al, [8][9][10] Bueno et al, 11 and Abu-Elmagd et al 12 of the University of Pittsburgh. Our technique has been routinely used at donor medical facilities without specialized equipment and has not precluded additional abdominal and thoracic organ retrieval.Multivisceral organ procurement requires tailoring the donor procedure for the individual needs of a recipient. Donor selection is restricted to optimal candidates according to widely recognized criteria 6,13 including ABO compatibility, appropriate size-match, minimal vasopressor requirements, absent/scant arrest period, serum sodium Ͻ 160 mEq/dL. Preparation of the donor before procurement includes selective intestinal decontamination using neomycin, erythromycin, and amphotericin B, in addition to intravenous antibiotic prophylaxis with a third-generation cephalosporin at the time of surgery. 12 Procurement of Multivisceral and Liver/Intestine AllograftsAll procedures begin with the standard techniques of abdominal organ procurement. 14 A thorough celiotomy is performed with particular attention to evidence of traumatic injury, the presence of mesenteric or retroperitoneal hematoma, and assessment of organ perfusion. The round ligament is divided, and the falciform is dissected to the hepatic vein/inferior vena cava confluence. Medially, the left coronary and triangular ligaments are released and the gastrohepatic ligament is assessed for aberrant hepatic arterial anatomy. The supraceliac dissection proceeds with division of the gastrohepatic ligament as well as the right diaphragmatic crus to expose the supraceliac aorta. 14 Infrarenal aortic dissection is initiated with medial rotation of the colon and duodenum en bloc as described by Cattel-Braash et al. 15 The inferior mesenteric vein is isolated and cannulated to begin a pre-cool perfusion with isotonic (donor serum sodium Ͻ 150 mEq/dL) or hypotonic (donor serum s...

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Clinical Intestinal Transplantation: A Decade of Experience at a Single Center

Cited by 349 publications

References 39 publications

Tolerogenic immunosuppression for organ transplantation

Tolerogenic immunosuppression for organ transplantation

Mucosal Vascular Alterations in Isolated Small‐Bowel Allografts: Relationship to Humoral Sensitization

Multivisceral and isolated intestinal procurement techniques

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