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Small bowel transplantation

S H Lauz Medeiros, A de Oliveira Menezes, L Zogbi, E Frasson de Souza Montero
BACKGROUND: The ischemia/reperfusion (I/R) phenomenon can cause the dysfunction of some transplanted organs and other distant organs. Liver surgery success, including transplantations, may depend on the adverse effects of intestinal mucosa injury arising from temporary porta triad occlusion. The study objective was to examine I/R liver effects on the small intestine in rats after N-acetylcysteine (NAC) treatment. METHODS: Twenty-four male Wistar rats were randomly divided into 2 groups...
September 2016: Transplantation Proceedings
Sumeeta Khurana, Nitya Batra
Toxoplasmosis in organ transplant patients can be a result of donor-transmitted infection, or reactivation of latent infection, or de novo infection. Solid organ transplants including heart, liver, kidney, pancreas and small bowel, and hematogenous stem cell transplants have been implicated in the risk of acquiring infection. In contrast to a benign course in immunocompetent individuals, the spectrum of illness is severe in transplant recipients. Clinical manifestations usually occur within the first 3 months of transplant and may present as encephalitis, pneumonitis, chorioretinitis, meningitis, and disseminated toxoplasmosis with multi-organ involvement...
July 2016: Tropical Parasitology
Pearlie P Chong, David van Duin, Jessica L Sonderup, Wendy J Grant, Andre C Kalil, Diana F Florescu
Solid organ transplant (SOT) recipients may develop protracted diarrheal illness from norovirus. We performed a retrospective chart review between January 2010 and April 2014 to identify predictors of persistent diarrhea in transplant recipients with norovirus enteritis. A total of 152 SOT recipients with mean age of 31.5 years (SD 23.1) were included: 43.4% male, 34.2% pediatric patients. Allograft types were abdominal 136 (89.5%) (kidney [39.5%], liver-small bowel [23%], other [27%]) and thoracic 16 (10...
October 6, 2016: Clinical Transplantation
Nicola de'Angelis, Francesco Esposito, Riccardo Memeo, Vincenzo Lizzi, Aleix Martìnez-Pérez, Filippo Landi, Pietro Genova, Fausto Catena, Francesco Brunetti, Daniel Azoulay
AIMS: Due to the increasing number of solid organs transplantations, emergency abdominal surgery in transplanted patients is becoming a relevant challenge for the general surgeon. The aim of this systematic review of the literature is to analyze morbidity and mortality of emergency abdominal surgery performed in transplanted patients for graft-unrelated surgical problems. METHODS: The literature search was performed on online databases with the time limit 1990-2015...
2016: World Journal of Emergency Surgery: WJES
Jamie Koo, David W Dawson, Sarah Dry, Samuel W French, Bita V Naini, Hanlin L Wang
In this study, we sought to determine the incidence of posttransplant complications including acute cellular rejection (ACR), infection, and posttransplant lymphoproliferative disease (PTLD) in mucosal allograft biopsies in patients with small bowel transplant at our institution. We retrospectively reviewed pathology reports from 5675 small bowel allograft biopsies from 99 patients and analyzed the following: indications for biopsy, frequency and grade of ACR, presence of infectious agents, results of work-up for potential PTLD, results of C4d immunohistochemistry (IHC), features of chronic mucosal injury, and findings in concurrent native bowel biopsies...
September 1, 2016: Clinical Transplantation
Monika Fischer, Dina Kao, Colleen Kelly, Aishwarya Kuchipudi, Syed-Mohammed Jafri, Mark Blumenkehl, Douglas Rex, Mark Mellow, Nirmal Kaur, Harry Sokol, Gwen Cook, Matthew J Hamilton, Emmalee Phelps, Brian Sipe, Huiping Xu, Jessica R Allegretti
BACKGROUND: New treatments are needed as Clostridium difficile infection (CDI) is becoming increasingly formidable. Fecal microbiota transplantation (FMT) has a 90% success rate in the treatment of recurrent CDI. However, evidence regarding its safety, efficacy, and effect on disease activity in patients with inflammatory bowel disease (IBD) is lacking. METHODS: This cohort study used data from 8 national and international academic centers. Patients with established IBD who underwent FMT for recurrent CDI were followed for a minimum of 3 months...
October 2016: Inflammatory Bowel Diseases
Amanda R Jensen, Morenci M Manning, Sina Khaneki, Natalie A Drucker, Troy A Markel
BACKGROUND: Transplantation of mesenchymal stromal cells (MSCs) may be a novel treatment for intestinal ischemia. The optimal stromal cell source that could yield maximal protection after injury, however, has not been identified. We hypothesized that (1) MSCs would increase survival and mesenteric perfusion, preserve intestinal histologic architecture, and limit inflammation after intestinal ischemia and reperfusion (I/R) injury, and (2) MSCs harvested from different sources of tissue would have equivalent protective properties to the intestine after I/R inury...
August 2016: Journal of Surgical Research
Waseem Q Anani, Adriana Zeevi, John G Lunz
OBJECTIVES: Luminex-based single-antigen bead human leukocyte antigen (HLA) antibody testing is widely used to define HLA antibodies for transplant compatibility. False-negative results can occur with complement-mediated prozone inhibition. This study assessed the effect of EDTA on the assay background reactivity and fluctuations in antibody mean fluorescent intensity. METHODS: Serum specimens were retrospectively tested using Luminex-based single-antigen beads with and without EDTA...
September 2016: American Journal of Clinical Pathology
Frank A Schildberg, Bin Liu, Mamdouh Afify, Julia Steitz, Pascal Paschenda, Nico Schäfer, Jörg C Kalff, Thomas Minor, René H Tolba
BACKGROUND: The long-term outcome of intestinal transplantations is still not favorable, which is partly due to the intestinal susceptibility to ischemia. There are several indications that the inflammatory response to ischemia-reperfusion injury is mediated by cyclooxygenases and that their inhibition may be associated with improved organ function. The aim of this study was to analyze if COX inhibitors could improve the early posttransplant outcome after orthotopic small bowel transplantation (SBTx)...
July 29, 2016: Transplantation
Karen van Hoeve, Ilse Hoffman, Fabio Fusaro, Jacques Pirenne, Ann Vander Auwera, Anne-Marie Dieltjens, Gert De Hertogh, Diethard Monbaliu, Marc Miserez
BACKGROUND: Microvillus inclusion disease (MVID) is a known congenital cause of intractable diarrhea resulting in permanent intestinal failure. There is need for a lifelong total parenteral nutrition (TPN) from diagnosis and the prognosis is poor. Most patients die by the second decade of life as a result of complications of parenteral alimentation including liver failure or sepsis. The only available treatment at this moment is a small bowel transplantation. But before that moment, the patients often suffer from a persistent failure to thrive and electrolyte disturbances despite continuous TPN...
August 1, 2016: Acta Chirurgica Belgica
Sabrina Furtado, Najma Ahmed, Sylviane Forget, Ana Sant'Anna
Aim. A multidisciplinary team was created in our institution to manage patients with intestinal failure (INFANT: INtestinal Failure Advanced Nutrition Team). We aimed to evaluate the impact of the implementation of the team on the outcomes of this patient population. Methods. Retrospective chart review of patients with intestinal failure over a 6-year period was performed. Outcomes of patients followed up by INFANT (2010-2012) were compared to a historical cohort (2007-2009). Results. Twenty-eight patients with intestinal failure were followed up by INFANT while the historical cohort was formed by 27 patients...
2016: Canadian Journal of Gastroenterology & Hepatology
Ina Jochmans, Jacques Pirenne
A 67-year-old woman with a 6-month history of malabsorption and malnourishment was referred for possible intestinal transplantation. She had a body-mass index (the weight in kilograms divided by the square of the height in meters) of 19. The patient was receiving only parenteral nutrition because..
July 14, 2016: New England Journal of Medicine
Martin W von Websky, Koji Kitamura, Isis Ludwig-Portugall, Christian Kurts, Maximilian von Laffert, Joel LeMaoult, Edgardo D Carosella, Kareem Abu-Elmagd, Joerg C Kalff, Nico Schäfer
The non-classical MHC I paralogue HLA-G is expressed by cytotrophoblast cells and implicated with fetomaternal tolerance by downregulating the maternal adaptive and innate immune response against the fetus. HLA-G expression correlates with favorable graft outcome in humans and recently promising immunosuppressive effects of therapeutic HLA-G in experimental transplantation (skin allograft acceptance) were shown. Consequently, we examined this novel therapeutic approach in solid organ transplantation. In this study, therapeutic recombinant HLA-G5 was evaluated for the first time in a solid organ model of acute rejection (ACR) after orthotopic intestinal transplantation (ITX)...
2016: PloS One
Huw Twamley, Andrew Haigh, Claire Williment, Cara Hudson, Julie Whitney, James Neuberger
OBJECTIVES: Anecdotal evidence suggests that organ donation from deceased donors referred to the Coroner/Procurator Fiscal (PF) could be increased if all followed best practice. The aim of this prospective audit was to establish how referrals affected organ donation and to develop evidence-based guidelines to ensure that organ donation can be facilitated safely without interfering in the Coroner/PF's investigative process. DESIGN: Prospective audit. SETTING: All acute National Health Service Hospitals in the UK where deceased organ donation was considered...
2016: BMJ Open
Victoria Shakhin, Kishore Iyer, Jaime Chu, Archana Ramaswami, Neil Lester, Ronen Arnon
Small bowel obstruction in a pediatric patient following liver transplant often results from adhesions, hernias, or post-transplant lymphoproliferative disease. Here, we present an unusual and previously unreported entity - Roux-en-Y intussusception in an eight-yr-old female several years after liver transplantation. Although a rare complication, Roux-en-Y intussusception should be considered as a potential etiology in the patient presenting with bowel obstruction, with specific attention to acute presentation accompanying jaundice...
September 2016: Pediatric Transplantation
H Vollmer, E Harvey, G Barker, D Young
No abstract text is available yet for this article.
December 2015: Intensive Care Medicine Experimental
Diana Sung, Alina C Iuga, Tomoaki Kato, Mercedes Martinez, Helen E Remotti, Stephen M Lagana
Crypt apoptosis in intestinal epithelium is an important diagnostic feature of graft-versus-host disease (GVHD) and acute cellular rejection (ACR) of intestinal transplants (ITx). In ITx pathology, 2 or fewer apoptotic bodies in 10 consecutive crypts are considered normal, whereas 6 or more is consistent with mild ACR. The presence of 3 to 5 apoptotic bodies is problematic and is often classified as indeterminate for ACR. The minimum diagnostic threshold for GVHD is controversial but also depends on the apoptotic body count (ABC)...
October 2016: Human Pathology
Ekaterina O Gubernatorova, Ernesto Perez-Chanona, Ekaterina P Koroleva, Christian Jobin, Alexei V Tumanov
Intestinal ischemia is a life-threatening condition associated with a broad range of clinical conditions including atherosclerosis, thrombosis, hypotension, necrotizing enterocolitis, bowel transplantation, trauma and chronic inflammation. Intestinal ischemia-reperfusion (IR) injury is a consequence of acute mesenteric ischemia, caused by inadequate blood flow through the mesenteric vessels, resulting in intestinal damage. Reperfusion following ischemia can further exacerbate damage of the intestine. The mechanisms of IR injury are complex and poorly understood...
2016: Journal of Visualized Experiments: JoVE
Lisa M Sharkey, Neil K Russell, Charlotte S Rutter, Stephen J Middleton, J Andrew Bradley, Neville V Jamieson, Andrew J Butler
BACKGROUND: Multivisceral transplantation (transplantation of the stomach, intestine, liver, and pancreas) is usually undertaken as a semi-elective procedure after thorough assessment in patients who have intestinal failure with cirrhosis, cirrhosis with portomesenteric venous thrombosis, or tumors such as desmoids involving the liver and mesentery. STUDY DESIGN: Data were collected prospectively from the time of referral and held in a central database. We used it to report the first cases of urgent multivisceral transplantation (MVT) in patients with widespread splanchnic ischemia (occlusion of the celiac axis and superior mesenteric artery) resulting in small bowel infarction and hepatic failure...
May 2016: Journal of the American College of Surgeons
L Moulin, C Rumbo, P Romero, N Pedraza, D Garcia Hervá, G Orce, J Trentadue, D Ramisch, G Gondolesi
BACKGROUND: We report the case of a 7-year-old girl with intestinal failure owing to a cystic lymphangioma compromising the root of the mesentery, not amenable to resection, leading to intestinal failure. Oncologic treatment was attempted to reduce tumor size with no response; therefore, she was listed for multivisceral transplantation. PROCEDURE: Resection of the tumor required resection of all abdominal organs with vascular inflow and outflow. A multivisceral graft (liver, stomach, duodenum-pancreas and spleen complex, small bowel, and right colon) was implanted...
March 2016: Transplantation Proceedings
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