Intestinal transplantation: the evaluation process

Robinson, Jill; Spencer, Rachel W.

doi:10.7182/prtr.15.1.3026gj4044584115

Progress in Transplantation

2005

DOI: 10.7182/prtr.15.1.3026gj4044584115

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Intestinal transplantation: the evaluation process

Jill Robinson¹,

Rachel W. Spencer²

Abstract: After 4 decades of development, the American Gastroenterological Association in a medical position statement recently declared intestinal transplantation to be an acceptable therapy for patients suffering from intestinal failure. Improvements in surgical technique, immunosuppression, and treatment of rejection and infection have contributed to this advancement. Early referral and candidate selection have also been cited as key components to a successful transplantation. The evaluation period, including the ref… Show more

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Cited by 3 publications

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“…The radiological evaluation of prospective candidates for intestinal transplantation must address a variety of clinical issues typical for these patients. These issues include central venous patency of the neck and chest region as well as the common femoral arteries and veins, pelvic veins, abdominal arterial and venous anatomy, large and small bowel anatomy and length, the presence of enterocutaneous fistulas, and liver and spleen volumes . Comorbid diseases must be addressed on an individual basis.…”

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confidence: 99%

Computed tomography (CT) colonography with CT arteriography and venography for the workup of intestinal transplant candidates

Swerdlow

Trotter

Girlanda

et al. 2012

Clinical Transplantation

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Prior to intestinal transplantation, prospective candidates must undergo a series of radiologic examinations to address a variety of clinical issues. To date, little literature exists to guide physicians in this preoperative assessment. Multiple imaging studies can provide overlapping information. We have developed a simple two- or three-test protocol to streamline the workup. Sixteen adult patients presented as potential intestinal transplant candidates to Georgetown University Hospital. All but two patients underwent the full protocol of a biphasic IV contrast-enhanced computed tomography (CT) scan of the chest, abdomen, and pelvis with rectal carbon dioxide, an upper gastrointestinal study with small bowel follow through, and fistulogram when appropriate. Three-dimensional (3-D) reconstructions of the vascular anatomy as well as the colon were also generated. A telephone survey to other transplant centers was additionally conducted to compare radiographic evaluations. Overall, 15 of the 16 scans were diagnostic. One patient required a barium enema. Mean examinations per patient was 2.4. Only one of seven other centers was performing CT colonography in prospective intestinal transplant candidates. Our protocol provided all the necessary anatomic information needed to evaluate prospective transplant candidates. CT colonography with angiography is a suitable alternative to more time-consuming radiological studies.

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mentioning

confidence: 99%

Computed tomography (CT) colonography with CT arteriography and venography for the workup of intestinal transplant candidates

Swerdlow

Trotter

Girlanda

et al. 2012

Clinical Transplantation

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show abstract

“…In summary, the two most common indications included PN-associated liver disease and a progressive loss of venous accesses for continued PN (9). Nevertheless, as intestinal transplantation advances other factors such as quality of life may be potential indications in selected cases (10). Hence, the following should be considered eligible for intestinal transplant -tumors with local abdominal invasion (desmoid tumor), non-reconstructable gastrointestinal tract, primary loss of an intestinal graft, and poor quality of life secondary to intestinal failure.…”

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confidence: 99%

Intestinal trasplantation

Castillo

2006

Rev. esp. enferm. dig.

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Until nearly three decades ago the small bowel was considered an organ unsuitable for transplantation, since its high lymphoid tissue contents, strong expression of histocompatibility antigens, and colonization by microorganisms made rejection and infection the rule. With the introduction of tacrolimus (FK-506) in 1989 the risk for rejection and fatal infection decreased, and the procedure became a reality and was initially used to rescue patients with intestinal failure. For almost a decade, however, complex patient care and the need for strong, long-term immune suppression prevented its widespread use. During the last few years technical innovations, new immunosuppressing protocols, and improved postoperative management have significantly increased the efficacy of this therapeutic procedure, which is more commonly used for patients with intestinal failure. Thus, data reported by the International Intestinal Transplant Registry in 2003 reflect an increased number of bowel transplants, particularly from 1997 on, as well as improved patient and graft survival (1). Intestinal transplantation is therefore a feasible therapeutic option for patients suffering from intestinal failure. This term is applied when patients cannot obtain adequate nutrition from an enteric diet, and thus need a portion of their caloric requirements from parenteral nutrition (PN) (2). Most commonly, intestinal failure results from surgical resection in order to treat the patient's condition, which yields a short bowel; in other instances, the bowel is sufficiently long, but unable to absorb fluids and nutrients necessary to meet the body's metabolic demands, thus resulting in intestinal failure. Causes differ in adults and children, but a short bowel is the most common indication (1). Thus in pediatric patients, the most common causes of intestinal failure requiring an intestinal transplant include gastroschisis (21%), volvulus (17%), dismotility (16%), necrotizing enterocolitis (12%), intestinal atresia (8%), and microvillous inclusion disease (6%). In contrast, in adults, ischemia (23%), Crohn's disease (14%), gastrointestinal neoplasms (16%), and trauma (10%) represent the most common indications leading to intestinal transplantation. Also a retransplant was performed in 8% of pediatric recipients and 6% of adult recipients (3). Two studies have shown that patient survival at 1 year after intestinal transplant is 92 and 88%, similar to survival with PN (4,5). However, while results have improved over time, long-term survival is not as good as with PN. Overall survival rates for patients with home parenteral nutrition is 85% at 3 years (6), while 3-year survival is 61% with intestinal transplantation (7). Thus, the indication for intestinal transplantation is currently restricted to patients where parenteral nutrition reached its limits, either from administration difficulties or because of serious complications contraindicating it. In 2003, the American Gastroenterological Association (AGA) (8) proposed intestinal transplant as a therapeut...

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Esophageal Varices in Chronic Intestinal Insufficiency in Absence of Portal Hypertension or Liver Cirrhosis: Case Report

Yandza

Schneider

Novellas

et al. 2010

Transplantation Proceedings

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Intestinal transplantation: the evaluation process

Cited by 3 publications

References 9 publications

Computed tomography (CT) colonography with CT arteriography and venography for the workup of intestinal transplant candidates

Computed tomography (CT) colonography with CT arteriography and venography for the workup of intestinal transplant candidates

Intestinal trasplantation

Esophageal Varices in Chronic Intestinal Insufficiency in Absence of Portal Hypertension or Liver Cirrhosis: Case Report

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