Intestinal transplantation for the treatment of neoplastic disease

Moon, Jang; Selvaggi, Gennaro; Nishida, Seigo; Levi, David; Kato, Tomoaki; Ruiz, Philip; Bejarano, P.A.; Madariaga, Juan; Tzakis, Andreas G.

doi:10.1002/jso.20416

Cited by 46 publications

(31 citation statements)

References 27 publications

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“…97 Since then, its shortterm outcomes have improved significantly and indications of either intestinal, liver-intestinal, or multivisceral (full/modified) transplantations 98 have expanded for a wide variety of tumors such as desmoid (Gardner's syndrome), neuroendocrine, adenocarcinoma, schwannoma, lymphoma, and sarcoma that would otherwise be unresectable. [99][100][101][102][103][104][105][106][107][108][109][110][111][112] Currently, there is no standardized indication of intestinal and multivisceral transplantation for neoplastic disease. However, for high-grade malignancies such as adenocarcinoma and lymphoma, the disappointing oncological results in the earlier series obviously warrant deliberate patient selection, if not contraindicated.…”

Section: Intestinal and Multivisceral Transplantationmentioning

confidence: 99%

“…However, for high-grade malignancies such as adenocarcinoma and lymphoma, the disappointing oncological results in the earlier series obviously warrant deliberate patient selection, if not contraindicated. 103 Because all patients are subject to life-long, intensive immunosuppression, the biological behavior of any neoplasm is essentially unpredictable and needs to be carefully weighed with the invasiveness of these procedures even if complete tumor removal is technically feasible. Novel immune monitoring techniques on the horizon [113][114][115][116][117][118][119][120] as well as accumulating evidence of the significance of donor specific antibodies 108,[121][122][123][124][125][126] are critical to surmount the immunological dilemma of preventing intestinal rejection, the Achilles' heel of transplanting small bowel contained allografts, 127 and tumor progression.…”

Section: Intestinal and Multivisceral Transplantationmentioning

confidence: 99%

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Current status of the organ replacement approach for malignancies and an overture for organ bioengineering and regenerative medicine

et al. 2014

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Section: Intestinal and Multivisceral Transplantationmentioning

confidence: 99%

Section: Intestinal and Multivisceral Transplantationmentioning

confidence: 99%

Current status of the organ replacement approach for malignancies and an overture for organ bioengineering and regenerative medicine

et al. 2014

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“…There are, however, several examples of patients with neoplasia being successfully transplanted, with subsequent cure of their malignancy and long-term survival (Moon et al 2005). Here again, the individual assessment of each patient based on the precise nature of their circumstances is crucial.…”

Section: Risk Assessment Of Patients On Parenteral Nutritionmentioning

confidence: 99%

Is intestinal transplantation now an alternative to home parenteral nutrition?

Middleton

2007

Proc. Nutr. Soc.

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Patients with irreversible intestinal failure and complications of parenteral nutrition should now be routinely considered for small intestine transplantation. Despite attempts for > 40 years immunological graft intolerance presented an impenetrable barrier to successful engraftment until the development in the late 1970s of the powerful calcineurin-inhibitor immunosuppressive agents. Their use over the last 17 years has led to small intestinal transplantation being generally considered as a routine option for patients with irreversible intestinal failure and failing parenteral nutrition. The 1-year patient survival rates ( %) are now excellent for renal (95), liver (78), heart (82) and lung (75) transplantation. In contrast, survival rates for small intestinal transplantation have been slow to improve, although they are now approaching those for lung and liver transplantation (intestine 78 %, intestine and liver 60 %, multivisceral 66 %), and well-performing centres report recent 1-year graft survival rates as high as 92 %. Patient 5-year survival ( %) has also improved (intestine alone 50, intestine and liver 50 and multivisceral 62) and compares increasingly favourably with renal (85), liver (67), heart (67) and lung (46). Currently, small intestinal transplantation is reserved for patients with irreversible small intestinal failure who have a poor prognosis on parenteral nutrition. However, as 5-year patient survival following intestinal transplantation approaches that for parenteral nutrition there will be increasing pressure to offer this modality of treatment as an alternative to parenteral nutrition, especially for those patients who have a poor quality of life as a result of parenteral nutrition. Parenteral nutrition: Small intestinal transplantation: Risk assessment: Survival:Intestinal failureThe short answer to this now frequently-asked question is yes, but only for certain patients in certain circumstances. Perhaps as a consequence of the exponential rise in the sophistication of medical treatments, patients with catastrophic loss of the small intestine, at least in the developed countries, are no longer treated in a palliative manner and are now offered salvage surgery and parenteral nutrition (PN) as a routine. The main concern in the art of intravenous feeding is getting the simple aspects consistently correct and paying attention to detail. It is a highly-skilled practice and is well established in the UK because of a relatively small number of dedicated clinicians. It is not, however, easily accessed by some patients in geographically-remote regions, and this lack of accessibility is currently the subject of much interest and debate. When used prudently and with care PN allows patients to have a good quality and length of life (Baxter et al. 2006). Given this good profile of PN, why take the added risks of small intestinal transplantation (SIT)? From the patient's perspective life without dependency on the intravenous infusion of water and nutrients, often daily over 8 h, is very attractive as ...

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“…In rare instances, such as Gardner's syndrome and in non-resectable neuroendocrine pancreatic tumors (NEPT), transplantation may be performed in selected patients [4].…”

Section: Introductionmentioning

confidence: 99%

Survival of patients evaluated for intestinal and multivisceral transplantation – the Scandinavian experience

Varkey

Simrén

Bosæus

et al. 2013

Scandinavian Journal of Gastroenterology

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Intestinal transplantation for the treatment of neoplastic disease

Abstract: Intestinal transplantation is a reasonable life-saving treatment for catastrophic intra-abdominal neoplastic diseases.

Cited by 46 publications

References 27 publications

Current status of the organ replacement approach for malignancies and an overture for organ bioengineering and regenerative medicine

Current status of the organ replacement approach for malignancies and an overture for organ bioengineering and regenerative medicine

Is intestinal transplantation now an alternative to home parenteral nutrition?

Survival of patients evaluated for intestinal and multivisceral transplantation – the Scandinavian experience

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