Ten-Year Experience With Bowel Transplantation at Seoul St. Mary's Hospital

Chang, Ha Kyun; Kim, S.Y.; Kim, J.I.; Kim, S.I.; Whang, Juho; Choi, Jong Young; Park, J.M.; Jung, Eun Sun; Rha, S.E.; Kim, D.G.; Moon, In-Sung; Lee, M.D.

doi:10.1016/j.transproceed.2015.12.065

Cited by 10 publications

(8 citation statements)

References 12 publications

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“…They worked on primarily long term outcomes. Chang et al (16) reported 4 cases or early mortality out of 15 patients (26%) but they called "early death" if it happened within the first 6 months. These studies don't comply with our definition of early mortality which considers the deaths happening within the first 48 hours.…”

Section: Discussionmentioning

confidence: 99%

The effect of perioperative electrolyte, acid-base balance, hemodynamic data and anesthetic management on early mortality of patients with small bowel transplantation

Güntürk¹,

Aydin²,

Karaman³

et al. 2018

Terh

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Objective: Due to high mortality rates, small bowel transplantation is a rarely applied intervention. In this study, we aimed to investigate the effects of perioperative hemodynamic data, electrolyte balance and blood gas parameters on early period mortality of the patients who underwent small bowel transplantation. Methods: The data of 23 patients, who had undergone small bowel transplantation in our clinic between 2004 and 2016, were examined retrospectively. All the patients' demographic data, causes of small bowel syndrome, perioperative hemodynamic data, electrolyte and blood gas values, blood replacement and early postoperative mortality rates within 48 hours were recorded. Statistical analysis was used to identify the parameters that effected early mortality. Results: The mean age of the 23 patients (13 female, and 10 male) was 34.54±15.2 years. Early period mortality was identified in four patients. When comparing demographic and clinic data with mortality, no statistically significant difference was found. There was a significant difference in pH, HCO3, BE values before and after reperfusion. No significant difference was found between electrolyte, blood gas values and early period mortality in the comparison of the same data. Conclusion: Many variables effect mortality in small bowel transplantation patients. We think that hemodynamic and metabolic changes should be monitored carefully in perioperative period to avoid early period mortality. ÖZ Amaç:Yüksek mortalite oranları nedeniyle ince bağırsak transplantasyonu oldukça nadir olarak uygulanan bir girişimdir. Bu çalışmada, ince barsak transplantasyonu uygulanan olguların peroperatif dönemdeki hemodinamik verilerini, elektrolit yönetimini, kan gazı değerlerinin erken dönem mortalite üzerine etkilerini araştırmayı amaçladık. Yöntem: 2004-2016 yılları arasında hastanemiz kliniğimizde ince barsak transplantasyonu operasyonu yapılmış olan 23 hastanın verileri retrospektif olarak incelendi. Tüm hastaların demografik verileri, kısa bağırsak sendromu nedenleri, peroperatif hemodinamik verileri, kan gazı değerleri, kan replasmanı ve postoperatif ilk 48 saat erken dönem mortalite oranları kaydedildi. Mortaliteyi etkileyen parametreleri tanımlamak için istatistiksel analiz yapıldı. Bulgular: Hastaların yaş ortalaması 34,54±15,2 olup, 13'ü kadın, 10'u erkek hastaydı. Erken dönem mortalite toplam 4 hastada gerçekleşti. Mortalite ile demografik ve klinik veriler karşılaştırıldığında istatistiksel olarak fark saptanmadı. Kan gazı ve elektrolit değerlerinin reperfüzyon öncesi ve sonrası karşılaştırılmasında sodyum, pH, HCO3, BE değerleri arasında anlamlı fark vardı. Aynı veriler erken dönem mortalite ile karşılaştırıldığında ise istatistiksel olarak anlamlı fark saptanmadı. Sonuç: İnce bağırsak transplantasyonu yapılan hastalarda mortalite üzerinde birçok değişken mevcuttur. Erken dönem mortaliteyi azaltmak açısından peroperatif dönemde hemodinamik ve metabolik değişikliklerin dikkatle izlenmesi gerektiğini düşünmekteyiz.

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Section: Discussionmentioning

confidence: 99%

The effect of perioperative electrolyte, acid-base balance, hemodynamic data and anesthetic management on early mortality of patients with small bowel transplantation

Güntürk¹,

Aydin²,

Karaman³

et al. 2018

Terh

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“…[109][110][111] Tacrolimus monotherapy is frequently used along with ALA induction in intestinal transplantation with favorable outcomes in terms of allograft survival and post-transplant complications. [51][52][53] In heart transplantation, the most notable evidence available on tacrolimus monotherapy is the TICTAC trial. 118 Routine monitoring for the TPMT polymorphism prior to azathioprine initiation is recommended in the non-transplant setting.…”

Section: Recommendation 5 Evidence Summary: Tacrolimus Monotherapymentioning

confidence: 99%

“…109,231,234,235 In intestinal transplantation, corticosteroids are a standard component of early-and long-term M-IMS regimens as illustrated by observational studies that persistently include them as essential components of M-IMS in this population. 51,52,[54][55][56][150][151][152][153]194,[243][244][245][246] In heart transplantation, most patients are either maintained on corticosteroids or withdrawal is attempted at 3-6 months or greater post-transplant. [247][248][249][250][251][252] At 1 and 5 years post-transplant, 89% and 52% of recipients, respectively, continued to be maintained on corticosteroids.…”

Section: Recommendation 9 Evidence Summary: Corticosteroid Withdrawalmentioning

confidence: 99%

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Consensus recommendations for use of maintenance immunosuppression in solid organ transplantation: Endorsed by the American College of Clinical Pharmacy, American Society of Transplantation, and the International Society for Heart and Lung Transplantation

et al. 2022

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Advances in maintenance immunosuppression over the past three decades have improved solid organ transplantation outcomes dramatically. Uninterrupted access to immunosuppression is paramount to minimize rejection and maintain allograft and patient survival. There is no standardized approach to maintenance immunosuppression management. Agents used vary based on transplanted organ, center‐specific protocol, provider expertise, insurance formularies, ability to cover co‐pays, recipient characteristics and tolerability. Published data reflects this heterogeneity. Despite this limitation, maintenance immunosuppression usage cross pollinates between organ groups with standard of care agents often being used off‐label, making medication access a challenge for many transplant recipients. A multidisciplinary panel of American transplant clinicians was formed to review published literature on maintenance immunosuppression with the goal to formulate consensus recommendations for their use in specific organ groups. These consensus recommendations are intended to provide transplant clinicians with a summary of literature on maintenance immunosuppression in the modern era and to support transplant team members working to secure medication access for patients.

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“…Chang et al9 at the Seoul St. Mary's Hospital reported that 5 children and 10 adults (6 months to 69 years of age) underwent bowel transplantation during 10 years. The primary diseases noted in adults included mesenteric vessel thrombosis in 4, strangulation in 2, and visceral myopathy, malignant gastrointestinal stromal tumor, mesenteric lymphangiectasis, and injury in each one.…”

mentioning

confidence: 99%

Living donor liver retransplantation for primary non-function of liver graft following multivisceral transplantation in a pediatric patient

Hwang

Kim

Namgoong

et al. 2020

Ann Hepatobiliary Pancreat Surg

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Multivisceral organ transplantation (MVOT) includes transplantation of three or more abdominal organs, generally including the small bowel, duodenum, stomach, liver, pancreas, and colon. We here presented the detailed procedures of repeat living donor liver transplantation for primary non-function of the first liver graft following MVOT in a pediatric patient. A 6-year-old girl with chronic intestinal pseudo-obstruction underwent MVOT with 5-year-old donor organs. However, the primary non-function of the liver graft developed, and an emergency living donor liver transplantation operation using a left lateral section graft was performed on the third day after MVOT. The donor was the patient's father. Portal flow interruption induced ischemic congestion of the whole small bowel, thus we used a series of porto-caval shunt to reduce the risk of ischemic splanchnic congestion during recipient hepatectomy and graft implantation. Other surgical procedures were the same as the standardized procedures for left liver graft implantation. The graft-recipient weight ratio was 2.15. The patient was managed conservatively for 3 months and discharged in an improved condition at 4 months after MVOT. She finally passed away at 22 months after MVOT. We think that our experience will be helpful for surgeons to cope with portal vein clamping-associated splanchnic congestion during liver transplantation and other abdominal surgeries.

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Ten-Year Experience With Bowel Transplantation at Seoul St. Mary's Hospital

Cited by 10 publications

References 12 publications

The effect of perioperative electrolyte, acid-base balance, hemodynamic data and anesthetic management on early mortality of patients with small bowel transplantation

The effect of perioperative electrolyte, acid-base balance, hemodynamic data and anesthetic management on early mortality of patients with small bowel transplantation

Consensus recommendations for use of maintenance immunosuppression in solid organ transplantation: Endorsed by the American College of Clinical Pharmacy, American Society of Transplantation, and the International Society for Heart and Lung Transplantation

Living donor liver retransplantation for primary non-function of liver graft following multivisceral transplantation in a pediatric patient

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