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"Intestinal transplant"

Theodoric Wong, Girish Gupte
Children with intestinal failure have had improved survival, particularly those with extreme short bowel syndrome, over the last 10-15 y. This has been attributed to better understanding of the pathophysiology of intestinal failure, improvement in line care, recognition of the importance of a team approach as well as the progress of intestinal transplant as a viable option. Parenteral nutrition remains the cornerstone for the continual survival of these patients. This review will cover contemporary approaches to intestinal failure including post surgical approaches, non-transplant surgery, dietetic and medication approaches during the adaptation process, considerations for home parenteral nutrition and latest in intestinal transplantation...
October 5, 2016: Indian Journal of Pediatrics
Guo-Sheng Wu
Antibody-mediated rejection (ABMR) has increasingly emerged as an important cause of allograft loss after intestinal transplantation (ITx). Compelling evidence indicates that donor-specific antibodies can mediate and promote acute and chronic rejection after ITx. However, diagnostic criteria for ABMR after ITx have not been established yet and the mechanisms of antibody-mediated graft injury are not well-known. Effective approaches to prevent and treat ABMR are required to improve long-term outcomes of intestine recipients...
September 24, 2016: World Journal of Transplantation
Alexander Kroemer, Christopher Cosentino, Jason Kaiser, Cal S Matsumoto, Thomas M Fishbein
Intestinal transplantation is the most immunologically complex of all abdominal organ transplants. Understanding the role both humoral and innate and adaptive cellular immunity play in intestinal transplantation is critical to improving outcomes and increasing indications for patients suffering from intestinal failure. Recent findings highlighting the impact of donor-specific antibodies on intestinal allografts, the role of NOD2 as a key regulator of intestinal immunity, the protective effects of innate lymphoid cells, and the role of Th17 in acute cellular rejection are reviewed here...
November 2016: Current Gastroenterology Reports
Undine Ariane Gerlach, Maren Klöpfel, Georgi Atanasov, Dietrich Polenz, Katrin Vogt, Stefanie Ahrlich, Marion Marksteiner, Anke Jurisch, Christoph Loddenkemper, Anja Reutzel-Selke, Birgit Sawitzki, Andreas Pascher
BACKGROUND: The pathology and diagnosis of acute and chronic rejection in intestinal transplantation are far from being completely understood. We established models of acute and chronic intestinal graft rejection and analysed peripheral and intragraft immune responses. METHODS: We performed intestinal transplantation (ITX) from Dark Agouti into Lewis rats applying single-dose tacrolimus (TAC) at varying concentrations. Graft histology and immunohistology were assessed on POD7,14,45...
September 8, 2016: Transplantation
Michael Sorrell, Alvaro Moreira, Kay Green, Rachel Jacobs, Robin Tragus, Laura Keller, Amy Quinn, Donald McCurnin, Alice Gong, Abeer El Sakka, Naveen Mittal, Cynthia Blanco
OBJECTIVES: To study the acute and long-term outcomes of preterm infants treated with an intravenous (IV) fish oil-based lipid emulsion (FishLE) for parenteral nutrition-associated liver disease (PNALD). METHODS: Preterm infants 14 days to 24 months of age with anatomic short gut or severe intestinal dysmotility, serum direct bilirubin ≥4 mg/dL, and requiring >60% calories from PN were eligible. Enrolled infants received 1 g/kg/day of FishLE until resolution of direct hyperbilirubinemia or return of enteral nutrition...
August 27, 2016: Journal of Pediatric Gastroenterology and Nutrition
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
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
Elaine Y Cheng, Matthew J Everly, Hugo Kaneku, Nubia Banuelos, Laura J Wozniak, Robert S Venick, Elizabeth A Marcus, Suzanne V McDiarmid, Ronald W Busuttil, Paul I Terasaki, Douglas G Farmer
BACKGROUND: Rejection remains the leading cause of allograft loss, and a major barrier to improving long-term outcomes following intestinal transplantation (ITx). Our aim is to define the prevalence and investigate the role of donor-specific antibody (DSA) on intestinal graft outcomes. METHODS: The study includes 109 transplants performed in 95 recipients at a single center. Patients were screened for DSA pretransplant, monitored regularly posttransplant and when clinically-indicated using the single-antigen bead Luminex assay...
August 3, 2016: Transplantation
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
Laurens J Ceulemans, Nathalie P Deferm, Marc Miserez, Francesca Maione, Diethard Monbaliu, Jacques Pirenne
Intestinal transplantation (ITx) is often associated with decreased abdominal domain, rendering abdominal closure difficult. Pre-transplant placement of tissue expanders (TE) can overcome this challenge; however it can be associated with life-threatening complications. This review aimed to comprehensively summarize all available literature on TE in ITx candidates and include the technical details of osmotic, self-inflatable TE -a technique undescribed before. PubMed, EMBASE and CCTR were searched until April 30, 2016...
October 2016: Transplantation Reviews
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
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
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
Julietta Chang, Mena Boules, John Rodriguez, Matthew Walsh, Raul Rosenthal, Matthew Kroh
BACKGROUND: Superior mesenteric artery syndrome (SMAS) is a rare condition caused by partial obstruction of the third portion of the duodenum by the SMA anteriorly and aorta posteriorly. Laparoscopic duodenojejunostomy has been described as a safe and feasible surgical intervention with favorable short-term outcomes. However, descriptions of intermediate outcomes are lacking in the literature. METHODS: A retrospective chart review was performed on patients who underwent minimally invasive duodenojejunostomy from March 2005 to August 2015 at our healthcare system with greater than 6-month follow-up...
July 12, 2016: Surgical Endoscopy
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
Andreas Pascher
No abstract text is available yet for this article.
July 1, 2016: Transplantation
Berkeley N Limketkai, Babak J Orandi, Xun Luo, Dorry L Segev, Jean-Frédéric Colombel
BACKGROUND & AIMS: Treatment of Crohn's disease (CD) may require multiple bowel resections that lead to short bowel syndrome. Intestinal transplantation is an effective treatment for short bowel syndrome, but limited data are available on long-term outcomes in CD. We aimed to characterize the long-term risk of rejection, graft failure, and death among CD patients after intestinal transplantation, and compare their outcomes with those of patients without CD. METHODS: We performed a retrospective study of adults in the Scientific Registry of Transplant Recipients who received intestinal transplants in the United States from May 1990 through June 2014...
June 29, 2016: Clinical Gastroenterology and Hepatology
K Miura, H Sahara, S Waki, A Kawai, M Sekijima, T Kobayashi, Z Zhang, T Wakai, A Shimizu, K Yamada
BACKGROUND: Clinical intestinal transplantation (Int-Tx) is associated with some problems such as rejection, infection, graft-versus-host disease, and ischemia-reperfusion injury (IRI). To determine mechanisms of rejection as well as to develop treatment strategies for Int-Tx, this study was designed to establish both heterotopic and orthotropic Int-Tx models using major histocompatibility antigen complex (MHC) inbred CLAWN miniature swine. MATERIALS AND METHODS: Eleven CLAWN miniature swine received MHC matched but minor antigen mismatched allogenic intestinal grafts...
May 2016: Transplantation Proceedings
Hendrik T J Mantel, Andrie C Westerkamp, René Adam, William F Bennet, Daniel Seehofer, Utz Settmacher, Francisco Sánchez-Bueno, Joan Fabregat Prous, Emmanuel Boleslawski, Styrbjörn Friman, Robert J Porte
Liver transplantation for hilar cholangiocarcinoma (hCCA) has regained attention since the Mayo Clinic reported their favorable results with the use of a neo-adjuvant chemoradiation protocol. However, debate remains whether the success of the protocol should be attributed to the neo-adjuvant therapy or to the strict selection criteria that are being applied. The aim of this study was to investigate the value of patient selection alone on the outcome of liver transplantation for hCCA. In this retrospective study, patients that were transplanted for hCCA between1990 and 2010 in Europe were identified using the European Liver Transplant Registry (ELTR)...
2016: PloS One
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
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