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"Multivisceral transplant"

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
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
Undine A Gerlach, Nils Lachmann, Giuseppina Ranucci, Birgit Sawitzki, Constanze Schoenemann, Johann Pratschke, Duska Dragun, Andreas Pascher
BACKGROUND: Non-HLA-allo- 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 anti-Angiotensin II type I receptor antibodies (anti-AT1R) and anti-Endothelin-Type A receptor antibodies (anti-ETAR) associated with the clinical course and histopathological findings of ITX-recipients. METHODS: 37 patients underwent intestinal or multivisceral transplantation...
August 5, 2016: Transplantation
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...
May 3, 2016: American Journal of Dermatopathology
Undine A Gerlach, Georgios Vrakas, Lydia Holdaway, Marion O'Connor, Rubens Macedo, Srikanth Reddy, Peter J Friend, Henk Giele, Anil Vaidya
The follow-up after intestinal transplantation (ITX) is complex and limited to specialized centers. ITX recipients often travel all over the country to be seen in the outpatient clinic of specialized centers which is costly and time-consuming. Videoconferences through Skype have been implemented to eliminate travel time, costs, and to improve patient compliance without jeopardizing safety. Eighteen of 19 patients followed up after ITX or modified multivisceral transplantation (MMVTX) in conventional outpatient clinics in Oxford agreed to attend additional Skype clinics...
July 2016: Clinical Transplantation
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, N Pedraza, J Padin, S Niveyro, G Tuhay, C Rumbo, P Barros Schelotto, A Crivelli, H Solar Muñiz, D Ramisch, G Gondolesi
CASE REPORT: A 24-year-old man diagnosed with Peutz-Jeghers syndrome as a child underwent multiple surgeries owing to intussusception. Pretransplant workup showed >150 polyps along the gastrointestinal (GI) tract, some of them with high-grade dysplasia. Despite having intestinal sufficiency, a modified multivisceral transplantation was offered. PROCEDURE: An 18-year-old donor was procured using University of Wisconsin solution. The recipient's surgery started with a midline incision...
March 2016: Transplantation Proceedings
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
J Calvo Pulido, M Manrique Municio, C Loinaz Segurola, I Justo Alonso, O Caso Maestro, A García-Sesma, F Cambra Molero, R San-Juan Garrido, M Abradelo de Usera, A Marcacuzco Quinto, E Moreno González, C Jiménez Romero
BACKGROUND: Surgical complications in multivisceral transplantation (MVT) are frequent and always severe. Those related to technical issues are relevant as they have implications not only on the graft but also on patient survival. The aim of this study was to review our case-based data and experience with 5 MVT performed since December 2004. CASE REPORT: A 38 year-old woman presented with ultra-short bowel syndrome due to massive ischemia also affecting the celiac trunk...
March 2016: Transplantation Proceedings
T Ambrose, L M Sharkey, J Louis-Auguste, C S Rutter, S Duncan, S English, E Gkrania-Klotsas, A Carmichael, J M Woodward, N Russell, D Massey, A Butler, S Middleton
BACKGROUND: Cytomegalovirus (CMV) disease is a common and clinically significant complication following intestinal or multivisceral transplantation. CMV disease is more common in cases of serologic mismatch between donor and recipient. Though in some cases it may be asymptomatic, in the immunosuppressed population it often manifests with evidence of systemic infection or end-organ disease. METHODS: We conducted a retrospective review of all patients undergoing intestinal or multivisceral transplantation over 8 years at our institution...
March 2016: Transplantation Proceedings
R Parekh, M Kazimi, S Skorupski, O Fagoaga, S Jafri, M C Segovia
BACKGROUND: We describe our experience using a modified protocol for immunosuppression for intestine transplantation across a positive crossmatch. Patients who underwent transplantation in 2013 were evaluated over a 12-month period for rejection and infectious events with comparison to procedure-matched controls on our standard protocol of immunosuppression. PATIENTS AND METHODS: We used a modified protocol for intestine and multivisceral transplantation for patients with a positive flow crossmatch...
March 2016: Transplantation Proceedings
B Rao, M C Segovia, M Kazimi, R Parekh, M Raoufi, S-M Jafri
Inhibitors of mechanistic target of rapamycin are used in solid organ transplant procedures to avoid calcineurin inhibitor complications, including nephrotoxicity and malignancy. We present 2 cases of multivisceral transplantation for neuroendocrine tumor (NET) for which everolimus was implemented for its potential to prevent NET recurrence as well as preserve renal function. The first case was complicated by NET recurrence in the liver before initiation of everolimus. After initiation of everolimus, the patient developed a ventral hernia and elevated aminotransferase levels with nonspecific biopsy findings...
March 2016: Transplantation Proceedings
H K Chang, S Y Kim, J I Kim, S I Kim, J K Whang, J Y Choi, J M Park, E S Jung, S E Rha, D G Kim, I S Moon, M D Lee
A retrospective review of intestinal transplantation (ITx) at Seoul St. Mary's Hospital was made by collecting clinical data over the past 10 years. Fifteen consecutive cases from 2004 were analyzed. Five children and 10 adults (6 months to 69 years of age) were included. Primary diseases in adults included 4 mesenteric vessel thromboses, 2 strangulations, and 1 each of visceral myopathy, malignant gastrointestinal stromal tumor (GIST), mesenteric lymphangiectasis, and injury. Pediatric cases involved 2 Hirschsprung disease, 2 visceral myopathy, and 1 necrotizing enterocolitis...
March 2016: Transplantation Proceedings
C S Rutter, I Amin, N K Russell, L M Sharkey, A J Butler, S J Middleton
Cambridge is one of two designated adult intestinal transplant centers in the United Kingdom and has performed 60 transplants on 54 patients since 2007; 52% of these were undertaken in the last 3 years. This increasing trend is in contrast with that reported worldwide; 27% were small bowel grafts (SBT), 15% modified multivisceral (MMVT), and 58% multivisceral (MVT). Median recipient age was 47 years; the female-to-male ratio was 27/33. Primary diseases included visceral arterial thromboses (17%), Crohn's disease (17%), motility disorders (12%), visceral venous thromboses (12%), familial adenomatous polyposis (FAP)/desmoids (8%), alcoholic cirrhosis (3%), nonalcoholic fatty liver disease (3%), ulcerative colitis (2%), and other (15%)...
March 2016: Transplantation Proceedings
D Ramisch, C Rumbo, C Echevarria, L Moulin, S Niveyro, G Orce, A Crivelli, M I Martinez, L Chavez, M A Paez, J Trentadue, F Klein, A Fernández, H Solar, G E Gondolesi
BACKGROUND: Intestinal failure (IF) patients received parenteral nutrition (PN) as the only available therapy until intestinal transplantation (ITx) evolved as an accepted treatment. The aim of this article is to report the long-term outcomes of a series of ITx performed in pediatric and adult patients at a single center 9 years after its creation. PATIENTS AND METHODS: This is a retrospective analysis of the ITx performed between May 2006 and January 2015. Diagnoses, pre-ITx mean time on PN, indications for ITx, time on the waiting list for types of ITx, mean total ischemia time, and warm ischemia time, time until PN discontinuation, incidence of acute and chronic rejection, and 5-year actuarial patient survival are reported...
March 2016: Transplantation Proceedings
Augusto Lauro, Cal S Matsumoto, Ignazio R Marino, Vincenzo Berghella
The largest experience of pregnancy after solid organ transplantation is recorded in renal and liver recipients. Intestinal/multivisceral transplantation has shown steady improvements in graft and patient survival over the past 20 years and is rapidly becoming more established: the first pregnancy after this procedure was described 10 years ago, and so far eight cases of pregnancies with 100% successful live births have been reported worldwide. Specifically to this procedure, there are 2 factors to be considered in case of pregnancy: absorptive function of transplanted bowel and higher need of immune-suppressants...
March 22, 2016: Journal of Maternal-fetal & Neonatal Medicine
J Cromvik, J Varkey, G Herlenius, J-E Johansson, C Wennerås
BACKGROUND: Graft-versus-host disease (GVHD) that develops after intestinal or multivisceral transplantation is difficult to diagnose and is associated with high morbidity and mortality. MATERIAL AND METHODS: The objectives of this study were to investigate the incidence, clinical picture, risk factors, and outcome of GVHD in a Scandinavian cohort of patients who underwent intestinal or multivisceral transplantation during a period of 16 years (1998-2014). All transplanted patients (n = 26) were retrospectively analyzed with respect to donor- and recipient-derived risk factors...
January 2016: Transplantation Proceedings
Shunji Nagai, Richard S Mangus, Eve Anderson, Burcin Ekser, Chandrashekhar A Kubal, Jonathan A Fridell, A Joseph Tector
BACKGROUND: Intestinal graft dysfunction is sometimes irreversible and requires allograft enterectomy with or without retransplantation. There is no comprehensive assessment of allograft enterectomy regarding indications and outcomes. The aim of this study was to evaluate management of patients with intestinal graft failure with special reference to indications and outcomes of allograft enterectomy and the procedure's validity as a bridge to retransplantation. METHODS: Graft and patient survivals, reason for graft failure, and rejection episodes were evaluated in 221 intestinal recipients (primary transplantation [n = 201], retransplantation [n = 20])...
February 19, 2016: Transplantation
Brett L Houston, Matthew Yan, Kathryn Tinckam, Suzanne Kamel-Reid, Hong Chang, Kevin H M Kuo, Cynthia Tsien, Matthew D Seftel, Yaron Avitzur, David Grant, Christine M Cserti-Gazdewich
BACKGROUND: Extracorporeal photopheresis (ECP) culls pathogenic T lymphocytes, be these the clones of cutaneous T-cell lymphoma, or mediators of chronic graft-versus-host disease (GVHD) after allogeneic bone marrow transplantation (BMT-GVHD). Whether or not ECP may have an effect in the rarer instances of solid organ transplantation-associated GVHD (SOT-GVHD) is unclear. Mortality rates in SOT-GVHD rival those of transfusion-associated GVHD, with fatalities preceded by pancytopenia and peripheral blood chimerism (PBC) levels exceeding 20%...
April 2016: Transfusion
Rodrigo Vianna, Thiago Beduschi
PURPOSE OF REVIEW: The development of diffuse splanchnic venous thrombosis continues to be a challenging undertaking for patients waiting for liver transplantation, requiring the utilization of highly complex surgical techniques. The aim of this article is to review the status of multivisceral transplantation (MVT) in the setting of diffuse portomesenteric thrombosis. RECENT FINDINGS: Even though many anatomical reconstructions of the venous system have been proposed to revascularize the transplanted liver, there are only few articles describing the use of these techniques...
April 2016: Current Opinion in Organ Transplantation
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