Urgent Multivisceral Transplantation for Widespread Splanchnic Ischemia

Sharkey, Lisa; Russell, Neil; Rutter, Charlotte; Middleton, Stephen; Bradley, J. Andrew; Jamieson, Neville V.; Butler, Andrew

doi:10.1016/j.jamcollsurg.2016.02.010

Cited by 11 publications

(4 citation statements)

References 18 publications

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“…Nutritional failure caused by any significant length bowel resection should be considered, screened for in the at‐risk patient and managed proactively. Multi‐visceral transplantation after widespread bowel ischaemia has been reported and may be considered in select cases [ 400 ].…”

Section: Introductionmentioning

confidence: 99%

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery

et al. 2021

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Aim There is a requirement for an expansive and up to date review of the management of emergency colorectal conditions seen in adults. The primary objective is to provide detailed evidence‐based guidelines for the target audience of general and colorectal surgeons who are responsible for an adult population and who practise in Great Britain and Ireland. Methods Surgeons who are elected members of the Association of Coloproctology of Great Britain and Ireland Emergency Surgery Subcommittee were invited to contribute various sections to the guidelines. They were directed to produce a pathology‐based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. Each author was asked to provide a set of recommendations which were evidence‐based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after two votes were included in the guidelines. Results All aspects of care (excluding abdominal trauma) for emergency colorectal conditions have been included along with 122 recommendations for management. Conclusion These guidelines provide an up to date and evidence‐based summary of the current surgical knowledge in the management of emergency colorectal conditions and should serve as practical text for clinicians managing colorectal conditions in the emergency setting.

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Section: Introductionmentioning

confidence: 99%

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery

et al. 2021

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“…The outcomes for intestine only rather than combined intestine/liver grafts in this circumstance are superior [3 && ]. Combined liver and intestinal grafts are necessary for certain cohorts of patients, namely those with cirrhosis and extensive portomesenteric venous thrombosis, where isolated liver transplant is precluded and those with acute abdominal vascular catastrophes and widespread splanchnic ischaemia [4].…”

Section: Indications For Intestinal and Multivisceral Transplantmentioning

confidence: 99%

Intestinal transplantation: an update

Sharkey¹,

Russell

2023

Current Opinion in Gastroenterology

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Purpose of reviewThe role of intestinal transplant has expanded in recent years and is no longer only considered for patients with no other options remaining. 5 year survival in high-volume centres is over 80% for certain graft types. The aim of this review is to update the audience on the current state of intestinal transplant, with a focus on recent medical and surgical advances. Recent findingsThere has been a greater understanding of the interplay and balance of host and graft immune responses, which may facilitate individualized immunosuppression. Some centres are now performing 'no-stoma' transplants, with preliminary data showing no adverse effects from this strategy and other surgical advances have lessened the physiological insult of the transplant operation. Earlier referrals are encouraged by transplant centres, such that vascular access or liver disease has not progressed too much to increase the technical and physiological challenge of the procedure. SummaryClinicians should consider intestinal transplant as a viable option for patients with intestinal failure, benign unresectable abdominal tumours or acute abdominal catastrophes.

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“…At the same time, new indications, not necessarily associated with intestinal failure or the associated complications, have gradually emerged. For example, MVTx is being increasingly performed for diffuse venous and even arterial splanchnic thrombosis and ischemia, particularly in Cambridge [21,22].…”

Section: Intestinal Rehabilitation Centersmentioning

confidence: 99%

Current state of adult intestinal transplantation in Europe

Clarysse

Canovai

Vanuytsel

et al. 2020

Current Opinion in Organ Transplantation

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Purpose of reviewIn Europe, adult intestinal transplantation (ITx) has continuously evolved since the first successful case in 1989. However, despite several recent innovations, no significant improvement in survival has been seen since 2005, illustrating the unique difficulty of transplanting the intestine. In this review, a subanalysis of adult ITx in Europe is discussed and recent publications on adult ITx in Europe are presented. Recent findingsIncreased medical and surgical arsenal in the treatment of intestinal failure reduce the need for ITx. At the same time, new indications (diffuse ischemia) have emerged. Static cold storage after vascular flush remains the gold standard but promising results are shown with additional luminal preservation. Pretransplant embolization facilitates multivisceral transplantation. Chronic rejection remains a major difficulty to tackle and currently, liver inclusion is the only effective strategy. Treatment of graft-versus-hostdisease remains debated. Quality of life substantially improves after successful ITx. ITx becomes costeffective three years after transplantation.

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Urgent Multivisceral Transplantation for Widespread Splanchnic Ischemia

Cited by 11 publications

References 18 publications

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery

Intestinal transplantation: an update

Current state of adult intestinal transplantation in Europe

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