Intestinal transplantation: an update

Fryer, Jonathan P.

doi:10.1097/01.mog.0000153313.43574.1b

Cited by 30 publications

(22 citation statements)

References 54 publications

(64 reference statements)

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“…Consistent with this general observation, ischemia/reperfusion injury causes pathological changes in gastrointestinal motility (Udassin et al 1995;Grossie et al 2001;Hakgüder et al 2002;Türler et al 2002). Intestinal ischemia can occur when the intestine is transplanted and because transplantation is being increasingly used to treat patients with severe disorders that are refractory to parenteral feeding (Fryer 2005), it is important to investigate the nature and mechanisms of neuronal damage. The persistent motility problems that sometimes follow transplantation are likely to be contributed to by I/R damage to enteric neurons (Türler et al 2002).…”

Section: Introductionmentioning

confidence: 70%

Deleterious effects of intestinal ischemia/reperfusion injury in the mouse enteric nervous system are associated with protein nitrosylation

et al. 2011

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Changes in intestinal function, notably impaired transit, following ischemia/reperfusion (I/R) injury are likely to derive, at least in part, from damage to the enteric nervous system. Currently, there is a lack of quantitative data and methods on which to base quantitation of changes that occur in enteric neurons. In the present work, we have investigated quantifiable changes in response to ischemia of the mouse small intestine followed by reperfusion from 1 h to 7 days. I/R caused distortion of nitric oxide synthase (NOS)-containing neurons, the appearance of a TUNEL reaction in neurons, protein nitrosylation and translocation of Hu protein. Protein nitrosylation was detected after 1 h and was detectable in 10% of neurons by 6 h in the ischemic region, indicating that reactive peroxynitrites are rapidly produced and can interact with proteins soon after reperfusion. Apoptosis, revealed by TUNEL staining, was apparent at 6 h. The profile sizes of NOS neurons were increased by 60% at 2 days and neurons were still swollen at 7 days, both in the ischemic region and proximal to the ischemia. The distribution of the enteric neuron marker and oligonucleotide binding protein, Hu, was significantly changed in both regions. Hu protein translocation to the nucleus was apparent by 3 h and persisted for up to 7 days. Particulate Hu immunoreactivity was observed in the ganglia 3 h after I/R but was never observed in control. Our observations indicate that effects of I/R injury can be detected after 1 h and that neuronal changes persist to at least 7 days. Involvement of NO and reactive oxygen species in the changes is indicated by the accumulation of nitrosylated protein aggregates and the swelling and distortion of nitrergic neurons. It is concluded that damage to the enteric nervous system, which is likely to contribute to functional deficits following ischemia and re-oxygenation in the intestine, can be quantified by Hu protein translocation, protein nitrosylation, swelling of nitrergic neurons and apoptosis.

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Section: Introductionmentioning

confidence: 70%

Deleterious effects of intestinal ischemia/reperfusion injury in the mouse enteric nervous system are associated with protein nitrosylation

et al. 2011

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“…Three men and five women with a mean age of 32 years (range, 15-65) and on HPN for 6.9 years (range, 2-20) were followed up from 2 to 11 years (mean, 6.1 years) after surgery. All eight (8) patients showed rapid improvements of their CIIPO symptoms after near total small bowel resection.…”

Section: Resultsmentioning

confidence: 99%

“…[2][3][4] Because of the improved survival with recent improvements in immunosuppressive therapy, IT has been done in lieu of HPN for end-stage CIIPO. [4][5][6] However, a recent editorial suggested that HPN is superior to transplantation in the long term. 7 Venting ostomies as advocated by some authors, [8][9][10] have improved the treatment of CIIPO in many patients, mostly children.…”

Section: Introductionmentioning

confidence: 95%

Chronic Idiopathic Intestinal Pseudo-obstruction Treated by Near Total Small Bowel Resection: A 20-Year Experience

2010

Journal of Gastrointestinal Surgery

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“…While clinical experiencewas limited to a few case reports prior to the 1990s, the world experience now includes approximately 1000 intestinal transplants (two-thirds in pediatric patients), with the number performed per year increasing every year [111]. 1.…”

Section: Indications For Transplantationmentioning

confidence: 99%

Short Bowel Syndrome: Parenteral Nutrition Versus Intestinal Transplantation. Where Are We Today?

et al. 2007

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Current management of short bowel syndrome (SBS) revolves around the use of home TPN (HPN). Complications include liver disease, catheter-related infections or occlusions, venous thrombosis, and bone disease. Patient survival with SBS on TPN is 86% and 75% at 2 and 5 years, respectively. Surgical management of SBS includes nontransplant surgeries such as serial transverse enteroplasty and reanastomosis. Small bowel transplant has become increasingly popular for management of SBS and is usually indicated when TPN cannot be continued. Posttransplant complications include graft-versus-host reaction, infections in an immunocompromised patient, vascular and biliary diseases, and recurrence of the original disease. Following intestinal-only transplants, patient and graft survival rate is 77% and 66% after 1 year. After 5 years the survival figures are 49% and 34%, respectively. Future improvements in survival and quality of life will enhance small bowel transplant as a viable treatment option for patients with SBS.

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Intestinal transplantation: an update

Cited by 30 publications

References 54 publications

Deleterious effects of intestinal ischemia/reperfusion injury in the mouse enteric nervous system are associated with protein nitrosylation

Deleterious effects of intestinal ischemia/reperfusion injury in the mouse enteric nervous system are associated with protein nitrosylation

Chronic Idiopathic Intestinal Pseudo-obstruction Treated by Near Total Small Bowel Resection: A 20-Year Experience

Short Bowel Syndrome: Parenteral Nutrition Versus Intestinal Transplantation. Where Are We Today?

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