Small Intestinal and Multivisceral Transplantation

2016 ◽  
Author(s):  
Bernard J. DuBray ◽  
Douglas G. Farmer
Keyword(s):  
Parenteral Nutrition ◽  
Graft Survival ◽  
Intestinal Failure ◽  
Intestinal Transplantation ◽  
Nutrition Therapy ◽  
Transplant Recipients ◽  
En Bloc ◽  
Multivisceral Transplantation ◽  
Rehabilitation Programs ◽  
Intestinal Transplant

The role of transplantation in the management of intestinal failure continues to evolve. Since the development of parenteral nutrition in the late 1960s, permanent intestinal failure has been medically managed with visceral transplantation, reserved for those who develop life-threatening complications. A multidisciplinary approach to intestinal care has led to the emergence of intestinal rehabilitation programs that have successfully achieved nutritional autonomy for many individuals through the promotion of adaptation. Whereas the short-term results of visceral transplantation have improved dramatically to the level of other solid organs, durable long-term graft survival has been elusive. This review covers intestinal failure, epidemiology, intestinal and multivisceral transplantation, and the future of intestinal and multivisceral transplantation. Figures show the embryonic origin of the multivisceral allograft, en bloc retrieval of the intestinal allograft, preparation for engraftment, vascularization of the isolated intestinal allograft, enteric reconstruction of the intestinal allograft, the liver-intestine allograft, preparation for liver-intestine engraftment, the modified multivisceral graft, arterial reconstruction in modified multivisceral transplantation, vascularization of the modified multivisceral allograft, recipient preparation in modified multivisceral transplantation, intestinal alloreactivity, graft survival among intestinal transplant recipients, patient survival among intestinal transplant recipients, candidates waiting for an intestine transplant, and distribution of candidates waiting for intestinal transplantation. Tables list causes of intestinal failure, predictors of outcome in intestinal failure, failure of total parenteral nutrition therapy as defined by the Centers for Medicare and Medicaid Services, histologic grading of acute cellular rejection, and criteria for chronic rejection in visceral allografts.   This review contains 16 highly rendered figures, 5 tables, and 54 references.

210 Survival Rate and Causes of Death on Home Parenteral Nutrition for Irreversible Intestinal Failure: Implications for Intestinal Transplantation

2010 ◽  
Vol 138 (5) ◽  
pp. S-39
Author(s):  
Loris Pironi ◽  
Francisca Joly ◽  
Alastair Forbes ◽  
Virginie Colomb ◽  
Malgorzata Lyszkowska ◽  
...  
Keyword(s):  
Survival Rate ◽  
Parenteral Nutrition ◽  
Causes Of Death ◽  
Intestinal Failure ◽  
Intestinal Transplantation ◽  
Home Parenteral Nutrition

scholarly journals International Latin American Survey on Pediatric Intestinal Failure Team

Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2754
Author(s):  
José Vicente N. Spolidoro ◽  
Mirella C. Souza ◽  
Helena A. S. Goldani ◽  
María N. Tanzi ◽  
Veronica B. Busoni ◽  
...  
Keyword(s):  
Latin America ◽  
Parenteral Nutrition ◽  
Latin American ◽  
Online Survey ◽  
Intestinal Failure ◽  
Median Number ◽  
International Standards ◽  
Standards Of Care ◽  
Number Of Children ◽  
Rehabilitation Programs

There is little data on the experience of managing pediatric Intestinal Failure (IF) in Latin America. This study aimed to identify and describe the current organization and practices of the IF teams in Latin America and the Caribbean. An online survey was sent to inquire about the existence of IF teams that managed children on home parenteral nutrition (HPN). Our questionnaire was based on a previously published European study with a similar goal. Twenty-four centers with pediatric IF teams in eight countries completed the survey, representing a total number of 316 children on HPN. The median number of children on parenteral nutrition (PN) at home per team was 5.5 (range 1–50). Teams consisted of the following members: pediatric gastroenterologist and a pediatric surgeon in all teams, dietician (95.8%), nurse (91.7%), social worker (79.2%), pharmacist (70.8%), oral therapist (62.5%), psychologist (58.3%), and physiotherapist (45.8%). The majority of the centers followed international standards of care on vascular access, parenteral and enteral nutrition, and IF medical and surgical management, but a significant percentage reported inability to monitor micronutrients, like vitamins A (37.5%), E (41.7%), B1 (66.7%), B2 (62.5%), B6 (62.5%), active B12 (58.3%); and trace elements—including zinc (29.2%), aluminum (75%), copper (37.5%), chromium (58.3%), selenium (58.3%), and manganese (58.3%). Conclusion: There is wide variation in how IF teams are structured in Latin America—while many countries have well-established Intestinal rehabilitation programs, a few do not follow international standards. Many countries did not report having an IF team managing pediatric patients on HPN.

scholarly journals Multivisceral Transplantation for Diffuse Portomesenteric Thrombosis: Lessons Learned for Surgical Optimization

2021 ◽  
Vol 8 ◽  
Author(s):  
Emilio Canovai ◽  
Laurens J. Ceulemans ◽  
Nicholas Gilbo ◽  
Nicolas M. Duchateau ◽  
Gert De Hertogh ◽  
...  
Keyword(s):  
Blood Loss ◽  
Intestinal Failure ◽  
Lessons Learned ◽  
Portal System ◽  
En Bloc ◽  
Multivisceral Transplantation ◽  
Life Threatening ◽  
Definitive Solution ◽  
Technical Solutions

Background: Multivisceral transplantation entails the en-bloc transplantation of stomach, duodenum, pancreas, liver and bowel following resection of the native organs. Diffuse portomesenteric thrombosis, defined as the complete occlusion of the portal system, can lead to life-threatening gastrointestinal bleeding, malnutrition and can be associated with liver and intestinal failure. Multivisceral transplantation is the only procedure that offers a definitive solution by completely replacing the portal system. However, this procedure is technically challenging in this setting. The aim of this study is to describe our experience, highlight the challenges and propose technical solutions.Materials and Methods: We performed a retrospective analysis of our cohort undergoing multivisceral transplantation for diffuse portomesenteric thrombosis at our institution from 2000 to 2020. Donor and recipient demographics and surgical strategies were reviewed in detail and posttransplant complications and survival were analyzed.Results: Five patients underwent MVTx. Median age was 47 years (23–62). All had diffuse portomesenteric thrombosis with life-threatening variceal bleeding. Major blood loss during exenteration was avoided by combining two techniques: embolization of the native organs followed by a novel, staged extraction. This prevented major perioperative blood loss [median intra-operative transfusion of 3 packed red blood cell units (0–5)]. Median CIT was 330 min (316–416). There was no perioperative death. One patient died due to invasive aspergillosis. Four others are alive and well with a median follow-up of 4.1 years (0.3–5.9).Conclusions: Multivisceral transplantation should be considered in patients with diffuse portomesenteric thrombosis that cannot be treated by any other means. We propose a standardized surgical approach to limit the operative risk and improve the outcome.

Impact of pediatric intestinal transplantation on intestinal failure in Japan: findings based on the Japanese intestinal transplant registry

2013 ◽  
Vol 29 (10) ◽  
pp. 1065-1070 ◽  
Author(s):  
Takehisa Ueno ◽  
Motoshi Wada ◽  
Ken Hoshino ◽  
Shinji Uemoto ◽  
Tomoaki Taguchi ◽  
...  
Keyword(s):  
Intestinal Failure ◽  
Intestinal Transplantation ◽  
Transplant Registry ◽  
Intestinal Transplant

Renal function in patients on long-term home parenteral nutrition and in intestinal transplant recipients

Nutrition ◽  
2014 ◽  
Vol 30 (9) ◽  
pp. 1011-1014 ◽  
Author(s):  
Loris Pironi ◽  
Augusto Lauro ◽  
Valentina Soverini ◽  
Chiara Zanfi ◽  
Federica Agostini ◽  
...  
Keyword(s):  
Renal Function ◽  
Parenteral Nutrition ◽  
Home Parenteral Nutrition ◽  
Transplant Recipients ◽  
Intestinal Transplant

scholarly journals The Long and Short of IT: intestinal failure-associated liver disease (IFALD) in adults—recommendations for early diagnosis and intestinal transplantation

2019 ◽  
Vol 11 (1) ◽  
pp. 34-39 ◽  
Author(s):  
Jeremy Mark Woodward ◽  
Dunecan Massey ◽  
Lisa Sharkey
Keyword(s):  
Liver Disease ◽  
Advanced Disease ◽  
Intestinal Failure ◽  
Intestinal Transplantation ◽  
Recent Experience ◽  
High Grade ◽  
Donor Liver ◽  
Non Invasive ◽  
Intestinal Transplant ◽  
Intestine Transplantation

Intestinal failure-associated liver disease (IFALD) often presents in adults unexpectedly with advanced disease. Non-invasive tests can be falsely reassuring. Patients with ‘ultrashort’ intestine (<20 cm) ending in a stoma are at particular risk of developing IFALD, which may occur rapidly. Recent experience and studies suggest that IFALD can be reversed by isolated intestine transplant occurring before the development of high grade fibrosis or cirrhosis. Post-transplant survival is superior for isolated intestinal grafts compared with liver containing intestinal grafts; waiting time and waiting list mortality is higher for a combined graft, and donor liver supply is limited. Therefore, the aim of clinicians treating patients with intestinal failure should be to identify IFALD early and refer to an intestinal transplant centre while isolated intestine transplantation can be contemplated and before the liver disease has progressed to a stage requiring consideration of combined liver and intestinal transplantation.

scholarly journals Pediatric Intestinal Failure Review

Children ◽  
2018 ◽  
Vol 5 (7) ◽  
pp. 100 ◽  
Author(s):  
Nisha Mangalat ◽  
Jeffrey Teckman
Keyword(s):  
Parenteral Nutrition ◽  
Pediatric Patients ◽  
Management Strategies ◽  
Intestinal Failure ◽  
Intestinal Transplantation ◽  
The Body

The term, ‘intestinal failure’, signifies the inability of the body to meet the digestive, absorptive and nutritive needs of the body. As such, these individuals require parenteral nutrition (PN) for survival. The subsequent nutritional, medical and surgical facets to the care are complex. Improved care has resulted in decreased need for intestinal transplantation. This review will examine the unique etiologies and management strategies in pediatric patients with intestinal failure.

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