Intestinal transplantation before and after the introduction of sirolimus1

Fishbein, Thomas M.; Florman, Sander; Gondolesi, Gabriel; Schiano, Thomas D.; LeLeiko, Neal S.; Tschernia, Allan; Kaufman, Stuart S.

doi:10.1097/00007890-200205270-00004

Cited by 106 publications

(55 citation statements)

References 17 publications

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“…Sinai Medical Center (31), and the University of California, Los Angeles (32). Infection and rejection continue to be barriers to more widespread application of the procedure.…”

Section: Intestinal Transplantationmentioning

confidence: 99%

Pediatric transplantation

Magee

Bucuvalas

Farmer

et al. 2004

American Journal of Transplantation

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“…Sinai Medical Center (31), and the University of California, Los Angeles (32). Infection and rejection continue to be barriers to more widespread application of the procedure.…”

Section: Intestinal Transplantationmentioning

confidence: 99%

Pediatric transplantation

Magee

Bucuvalas

Farmer

et al. 2004

American Journal of Transplantation

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“…In heart transplant recipients, de novo use of sirolimus has proven to reduce the incidence of acute rejection and allograft vasculopathy with comparable patient survival (4). However, its potent anti-proliferative action has been associated with poor wound healing in liver, small intestine, kidney and lung transplant recipients (1,(5)(6)(7)(8). In kidney transplant recipients, both prospective and retrospective studies have shown an increased rate of post-surgical wound healing complications when sirolimus was used in de novo immunosuppressive regimen (1,8).…”

Section: Introductionmentioning

confidence: 99%

Wound Healing Complications with De Novo Sirolimus Versus Mycophenolate Mofetil-Based Regimen in Cardiac Transplant Recipients

Kuppahally

Al-Khaldi²,

Weisshaar

et al. 2006

American Journal of Transplantation

138

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Sirolimus was introduced in de novo immunosuppression at Stanford University in view of its favorable effects on reduced rejection and cardiac allograft vasculopathy. After an apparent increase in the incidence of post-surgical wound complications as well as symptomatic pleural and pericardial effusions, we reverted to a mycophenolate mofetil (MMF)-based regimen. This retrospective study compared the outcome in heart transplant recipients on sirolimus (48 patients) with those on MMF (46 patients) in de novo immunosuppressive regimen. The incidence of any post-surgical wound complication (52% vs. 28%, p = 0.019) and deep surgical wound complication (35% vs. 13%, p = 0.012) was significantly higher in patients on sirolimus than on MMF. More patients on sirolimus also had symptomatic pleural (p = 0.035) and large pericardial effusions (p = 0.033) requiring intervention. Logistic regression analysis showed sirolimus (p = 0.027) and longer cardiac bypass time (OR = 1.011; p = 0.048) as risk factors for any wound complication. Sirolimus in de novo immunosuppression after cardiac transplantation was associated with a significant increase in the incidence of post-surgical wound healing complications as well as symptomatic pleural and pericardial effusions.

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“…In case of irreversible hepatic damage from parenteral nutrition (more frequent in children), the liver should also be transplanted (2,3). The introduction of tacrolimus as an immunosuppressor in the nineties, and the systematic use of induction protocols (anti-CD25, thymoglobulin, Campath 1-H) have reduced the incidence of rejection, and increased survival (3,5,6). At present, more than 80% of patients can perform normal daily activities and tolerate full oral feeding (1,2,3,6).…”

Section: Discussionmentioning

confidence: 99%

Non-anatomical intestinal transplantation

Charco

Malagelada

Llopart

et al. 2009

Rev. esp. enferm. dig.

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Introduction: intestinal transplantation is the only long-range treatment option for patients with intestinal failure. We report an exceptional case of isolated intestinal transplantation with the implant in a non-anatomical position.Clinical case: the patient was a thirty-eight-year-old man (60 kg weight, 180 cm height, 18.3 body mass index) with intestinal failure and home parenteral nutrition due to a short-bowel syndrome for which intestinal transplantation was indicated. The patient had a vascular malformation with the cava vein located left to the aorta, and the intestine was implanted with a 180°rotation around the mesenteric axis, so that the implant's superior mesenteric artery and vein matched the recipient's cava and aorta. Postoperative follow-up was excellent and the patient was discharged after six weeks with a 10-kg gain in body weight.Discussion: this non-anatomical intestinal implantation of the small bowel, previously unreported, offers technical advantages over other options. Adequate intestinal function represents a unique model to prove the viability of intestinal implants in a nonanatomical position.

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Intestinal transplantation before and after the introduction of sirolimus1

Abstract: An immunosuppressive regimen that includes sirolimus has improved graft survival. Furthermore, this regimen has significantly decreased the incidence of early rejection and has eliminated early graft loss caused by fulminant rejection.

Cited by 106 publications

References 17 publications

Pediatric transplantation

Pediatric transplantation

Wound Healing Complications with De Novo Sirolimus Versus Mycophenolate Mofetil-Based Regimen in Cardiac Transplant Recipients

Non-anatomical intestinal transplantation

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