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Multivisceral transplant

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https://www.readbyqxmd.com/read/28422396/a-simplified-multivisceral-transplantation-procedure-for-patients-with-combined-end-stage-liver-disease-and-type-2-diabetes-mellitus
#1
Xiao-Shun He, Shun-Jun Fu, Qiang Zhao, Xiao-Feng Zhu, Dong-Ping Wang, Ming Han, Wei-Qiang Ju, Yi Ma, Jiao Xing-Yuan, Xiao-Peng Yuan, An-Bin Hu, Zhi-Yong Guo
In liver transplant patients with type 2 diabetes mellitus (DM), the disease worsens after transplantation because of long-term use of diabetogenic immunosuppressive drugs, making management of those patients a great challenge. The objective of our study was to evaluate the safety and efficacy of a simplified multivisceral transplantation (SMT) procedure for the treatment of patients with end-stage liver disease and concurrent type 2 DM. Forty-four patients who had pretransplant type 2 DM were included. Twenty-three patients received SMT and 21 patients received orthotopic liver transplantation (OLT)...
April 19, 2017: Liver Transplantation
https://www.readbyqxmd.com/read/28393434/multivisceral-transplantation-for-abdominal-tumors-in-children-a-single-center-experience-and-review-of-the-literature
#2
Eliza Lee, Nicole Hodgkinson, Rima Fawaz, Khashayar Vakili, Heung Bae Kim
Standard management of intra-abdominal pediatric solid tumors requires complete resection. However, tumors with multiple organ and vascular involvement present a unique surgical challenge. We conducted a retrospective chart review of four patients, aged 2-14 years, undergoing MVT for intra-abdominal tumors with significant involvement of the visceral arteries and/or portomesenteric venous system at our institution. Indications for MVT included hepatocellular carcinoma, inflammatory myofibroblastic tumor, and two cases of hepatoblastoma...
April 9, 2017: Pediatric Transplantation
https://www.readbyqxmd.com/read/28362060/maintenance-immunosuppression-for-adults-undergoing-liver-transplantation-a-network-meta-analysis
#3
REVIEW
Manuel Rodríguez-Perálvarez, Marta Guerrero-Misas, Douglas Thorburn, Brian R Davidson, Emmanuel Tsochatzis, Kurinchi Selvan Gurusamy
BACKGROUND: As part of liver transplantation, immunosuppression (suppressing the host immunity) is given to prevent graft rejections resulting from the immune response of the body against transplanted organ or tissues from a different person whose tissue antigens are not compatible with those of the recipient. The optimal maintenance immunosuppressive regimen after liver transplantation remains uncertain. OBJECTIVES: To assess the comparative benefits and harms of different maintenance immunosuppressive regimens in adults undergoing liver transplantation through a network meta-analysis and to generate rankings of the different immunosuppressive regimens according to their safety and efficacy...
March 31, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28273399/clinical-presentation-and-outcomes-of-norovirus-infection-in-intestinal-allograft-compared-to-native-intestine
#4
Diana F Florescu, Jessica L Sonderup, Wendy Grant, Pearlie P Chong, David van Duin, Andre C Kalil
BACKGROUND: No data are available on clinical manifestations and course of norovirus gastroenteritis (NVE) in intestinal allograft (from intestinal and multivisceral transplant recipients, ITR) compared to native intestine (from other allograft recipients, nITR). METHODS: This was a retrospective study of solid organ transplant recipients with NVE at two centers from January 1, 2010 to April 1, 2014. Chi-square, t-test, linear and logistic regression analyses were done to compare NVE in ITR vs nITR patients...
March 8, 2017: Transplant Infectious Disease: An Official Journal of the Transplantation Society
https://www.readbyqxmd.com/read/28151808/techniques-for-abdominal-wall-reconstruction-in-intestinal-transplantation
#5
Gabriel E Gondolesi, Nicolás F Aguirre
PURPOSE OF REVIEW: One of the most important challenges in the intestinal (ITx) and multivisceral transplant (MVTx) is to achieve a successful abdominal wall closure. RECENT FINDINGS: A tension-free primary closure should be our aim. In most of the cases, we need to perform a component separation technique, alone or combined, to the use of a synthetic mesh. If those options are not feasible, the abdominal wall composite vascularized allograft transplant (AW-CVA) utilizing direct orthotopic vascularization can be considered...
February 1, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28147371/crohn-s-disease-and-intestinal-transplantation
#6
Pavel Drastich, Martin Oliverius
BACKGROUND: Most patients with Crohn's disease (CD) require one or more operations during their lifetime. Repeated resections and surgical complications may result in short gut in a subset of patients, typically those with extensive small bowel disease or a penetrating CD phenotype. The effects of short bowel syndrome (SBS) can range in seriousness from mild to life-threatening advanced intestinal failure. Worldwide, CD is the second leading indication for intestinal transplantation (ITx) in SBS, but the overall incidence of ITx is quite low...
2017: Digestive Diseases
https://www.readbyqxmd.com/read/28130374/current-status-of-intestinal-and-multivisceral-transplantation
#7
REVIEW
Shishira Bharadwaj, Parul Tandon, Tushar D Gohel, Jill Brown, Ezra Steiger, Donald F Kirby, Ajai Khanna, Kareem Abu-Elmagd
Clinical-nutritional autonomy is the ultimate goal of patients with intestinal failure (IF). Traditionally, patients with IF have been relegated to lifelong parenteral nutrition (PN) once surgical and medical rehabilitation attempts at intestinal adaptation have failed. Over the past two decades, however, outcome improvements in intestinal transplantation have added another dimension to the therapeutic armamentarium in the field of gut rehabilitation. This has become possible through relentless efforts in the standardization of surgical techniques, advancements in immunosuppressive therapies and induction protocols and improvement in postoperative patient care...
January 26, 2017: Gastroenterology Report
https://www.readbyqxmd.com/read/28088400/hospitalizations-for-respiratory-syncytial-virus-and-vaccine-preventable-infections-in-the-first-2-years-after-pediatric-liver-transplant
#8
Amy G Feldman, Shikha S Sundaram, Brenda L Beaty, Allison Kempe
OBJECTIVES: To examine in liver transplant recipients at centers participating in the Pediatric Health Information System dataset the number of hospitalizations for respiratory syncytial virus (RSV) and vaccine-preventable infections (VPIs) in the first 2 years after transplantation, morbidity and mortality associated with these hospitalizations, and costs associated with these hospitalizations. STUDY DESIGN: A retrospective cohort study of patients <18 years of age who underwent liver transplantation at a Pediatric Health Information System center between January 1, 2004, and December 31, 2012...
March 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/28052307/ultrashort-bowel-syndrome-outcome-in-children-treated-in-a-multidisciplinary-intestinal-rehabilitation-unit
#9
Mariela Dore, Paloma Triana Junco, Ane Andres Moreno, Vanesa Nuñez Cerezo, Martha Romo Muñoz, Alba Sánchez Galán, Alejandra Vilanova Sánchez, Gerardo Prieto, Esther Ramos, Francisco Hernandez, Leopoldo Martínez Martínez, Manuel Lopez Santamaria
Aim Short bowel syndrome (SBS) is the leading cause of intestinal failure (IF) in the pediatric population. Our aim was to review long-term outcome of ultrashort bowel syndrome (USBS) in an Intestinal Rehabilitation Unit (IRU). Patients and Methods Retrospective study of patients with USBS (defined as < 10 cm of remnant small bowel) treated between 2000 and 2015. Demographic data, clinical, and treatment variables including parenteral nutrition (PN), surgical techniques, and intestinal transplantation (IT) were analyzed...
February 2017: European Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/27990484/initial-experience-of-video-capsule-endoscopy-after-intestinal-transplantation
#10
Jonas Varkey, Mihai Oltean, Andreas Bernd Pischel, Magnus Simrén, Gustaf Herlenius
BACKGROUND: Intestinal transplantation is a procedure which inflicts immunological and infectious complications that affect the transplanted graft, posing both diagnostic and therapeutic challenges. Video capsule endoscopy (VCE) offers easy access to the entire small intestine and presents itself as an interesting option. However, at present, no studies evaluating the usefulness of video capsule endoscopies in this setting have been published. Our aim was to evaluate the usefulness of VCE in detecting complications that arise after intestinal transplantation...
December 2016: Transplantation Direct
https://www.readbyqxmd.com/read/27941430/long-term-persistence-of-innate-lymphoid-cells-in-the-gut-after-intestinal-transplantation
#11
Joshua Weiner, Julien Zuber, Brittany Shonts, Suxiao Yang, Jianing Fu, Mercedes Martinez, Donna Farber, Tomoaki Kato, Megan Sykes
BACKGROUND: Little is known about innate lymphoid cell (ILC) populations in the human gut, and the turnover of these cells and their subsets after transplantation has not been described. METHODS: Intestinal samples were taken from 4 isolated intestine (ITx) and 3 multivisceral (MvTx) transplant recipients at the time of any operative resection, such as stoma closure or revision. ILCs were isolated and analyzed by flow cytometry. The target population was defined as being negative for lineage markers and double-positive for CD45/CD127...
December 8, 2016: Transplantation
https://www.readbyqxmd.com/read/27932149/portal-vein-inflow-from-enlarged-coronary-vein-in-liver-transplantation-surgical-approach-and-technical-tips-a-case-report
#12
M Safwan, S Nagai, M S Abouljoud
Portal vein thrombosis is common in patients with end-stage liver disease, with an incidence as high as 26% in liver transplant candidates. It is known to be associated with a high risk of morbidity and mortality posttransplantation, and its management can be challenging. The management options range from a simple thrombendvenectomy to multivisceral transplantation in cases with diffuse portomesenteric thrombosis. We report a case of liver transplantation in which we performed a rare reconstruction of the portal vein...
November 2016: Transplantation Proceedings
https://www.readbyqxmd.com/read/27889929/twenty-eight-years-of-intestinal-transplantation-in-paris-experience-of-the-oldest-european-center
#13
Florence Lacaille, Sabine Irtan, Laurent Dupic, Cécile Talbotec, Fabrice Lesage, Virinie Colomb, Nadège Salvi, Florence Moulin, Frédérique Sauvat, Yves Aigrain, Yann Revillon, Olivier Goulet, Christophe Chardot
Our aim was to describe our achievements in pediatric intestinal transplantation (ITx) and define areas for improvement. After a period (1987-1990) of nine isolated small bowel transplants (SBTx) where only one patient survived with her graft, 110 ITx were performed on 101 children from 1994 to 2014: 60 SBTx, 45 liver-small bowel, four multivisceral (three with kidneys), and one modified multivisceral. Indications were short bowel syndrome (36), motility disorders (30), congenital enteropathies (34), and others (1)...
February 2017: Transplant International: Official Journal of the European Society for Organ Transplantation
https://www.readbyqxmd.com/read/27788782/could-sentinel-skin-transplants-have-some-utility-in-solid-organ-transplantation
#14
J M Ali, P Catarino, J Dunning, H Giele, G Vrakas, J Parmar
Accurate diagnosis of allograft rejection can be hazardous and challenging. A strategy that has emerged from experience with vascularized composite allografts (VCAs) is the use of sentinel skin transplants (SSTs)-portions of donor skin transplanted synchronously to an allograft. Work in nonhuman animal models and experience with VCAs suggest concordance between rejection occurring in the primary allograft and the SST, and that appearance of rejection in the SST may precede rejection in the primary allograft, permitting early therapeutic intervention that may improve outcomes with lower rates of chronic rejection...
October 2016: Transplantation Proceedings
https://www.readbyqxmd.com/read/27569969/hospital-readmissions-after-intestinal-and-multivisceral-transplantation
#15
Y K Kwon, K Etesami, A L Sharp, C S Matsumoto, T M Fishbein, R Girlanda
BACKGROUND: Intestinal transplant recipients require frequent hospital readmission after a successful transplantation, but the reasons for readmission have not been characterized in detail. METHODS: We reviewed our single-center experience to characterize the patterns of readmissions and to identify preventable causes. Among 87 adult patients who received an intestinal or multivisceral transplant, 65 patients (35 males, 30 females; median age, 42 years [range, 19-66]) with a follow-up of at least 1 year were included in this study...
July 2016: Transplantation Proceedings
https://www.readbyqxmd.com/read/27495916/the-abdominal-wall-transplant-as-a-sentinel-skin-graft
#16
James Barnes, Fadi Issa, Georgios Vrakas, Peter Friend, Henk Giele
PURPOSE OF REVIEW: Abdominal wall transplantation is a technique used to achieve abdominal closure after intestinal and multivisceral transplantation. This review focuses on whether there are additional benefits for the skin component as an immune-monitoring tool. RECENT FINDINGS: The largest series of abdominal wall transplants has recently been published. Alongside the physiological advantage gained in abdominal closure, the authors describe the immunological insight that the skin component can provide and how this contributes to the management of patients...
October 2016: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/27495766/non-hla-antibodies-may-accelerate-immune-responses-after-intestinal-and-multivisceral-transplantation
#17
Undine Ariane Gerlach, Nils Lachmann, Giuseppina Ranucci, Birgit Sawitzki, Constanze Schoenemann, Johann Pratschke, Duska Dragun, Andreas Pascher
BACKGROUND: Non-HLA alloantibodies and autoantibodies are involved in allograft rejection in kidney and heart transplantation. Their role in intestinal transplantation has not yet been described. We examined the development of antiangiotensin II type I receptor antibodies (anti-AT1R) and antiendothelin type A receptor antibodies associated with the clinical course and histopathological findings of intestinal transplantation recipients. METHODS: Thirty-seven patients underwent intestinal or multivisceral transplantation...
January 2017: Transplantation
https://www.readbyqxmd.com/read/27492796/frequency-and-risks-associated-with-clostridium-difficile-associated-diarrhea-after-pediatric-solid-organ-transplantation-a-single-center-retrospective-review
#18
J Ciricillo, D Haslam, S Blum, M-O Kim, C Liu, G Paulsen, J Courter, L Danziger-Isakov
BACKGROUND: Morbidity and mortality related to Clostridium difficile infection (CDI) has increased, but epidemiology and risk factors within pediatric solid organ transplant (SOT) recipients are uncertain. METHODS: A retrospective cohort study of SOT recipients age ≤18 years at transplantation from 2010 to 2013 was performed. Patients with CDI were compared with matched CDI-negative controls with diarrhea. RESULTS: Of 202 patients, the majority were male (58%) and Caucasian (77%)...
October 2016: Transplant Infectious Disease: An Official Journal of the Transplantation Society
https://www.readbyqxmd.com/read/27421821/megacystis-microcolon-intestinal-hypoperistalsis-syndrome-case-series-and-updated-review-of-the-literature-with-an-emphasis-on-urologic-management
#19
REVIEW
Kevin M Wymer, Blake B Anderson, Ashley A Wilkens, Mohan S Gundeti
INTRODUCTION: Megacystis microcolon intestinal hypoperistalsis (MMIHS) is a rare disorder characterized by distended nonobstructed bladder, microcolon, and decreased intestinal peristalsis. MMIHS has a particularly poor prognosis; however, when appropriately managed, survival can be prolonged. STUDY DESIGN: A systematic review (1996-2016) was performed with the key words "megacystis microcolon intestinal hypoperistalsis syndrome." In addition, a case series of four patients is presented as well as algorithms for the diagnosis and treatment of MMIHS...
September 2016: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/27149335/scleromatous-changes-in-an-abdominal-wall-graft-graft-versus-graft-disease-or-chronic-graft-rejection
#20
Nicholas J Olson, Daniel B Wimmer, Daniel P Croitoru, Dorothea T Barton, Gregory D Seidel, M Shane Chapman, Konstantinos Linos
Abdominal wall transplants are relatively new procedures that are frequently performed in conjunction with multivisceral transplants. The skin of the abdominal wall transplant is often the first site for graft rejection to manifest itself. Prompt recognition can lead to appropriate treatment before the involvement of the underlying viscera. However, the signs of graft rejection are nonspecific and can overlap with other entities. We present a case of a patient who received a multivisceral and abdominal wall transplant from 2 different donors, who presented with acute and eventually chronic graft rejection of the abdominal wall graft...
January 2017: American Journal of Dermatopathology
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