scholarly journals Choice of Allograft in Patients Requiring Intestinal Transplantation: A Critical Review

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
Genevieve Huard ◽  
Thomas Schiano ◽  
Jang Moon ◽  
Kishore Iyer
Keyword(s):  
Patient Survival ◽  
Intestinal Failure ◽  
Intestinal Transplantation ◽  
Advanced Fibrosis ◽  
Polyposis Syndrome ◽  
Gastrointestinal Pathology ◽  
Life Threatening ◽  
Intestine Transplantation ◽  
Waitlist Mortality

Intestinal transplantation (ITx) is indicated in patients with irreversible intestinal failure (IF) and life-threatening complications related to total parenteral nutrition (TPN). ITx can be classified into three main types. Isolated intestinal transplantation (IITx), that is, transplantation of the jejunoileum, is indicated in patients with preserved liver function. Combined liver-intestine transplantation (L-ITx), that is, transplantation of the liver and the jejunoileum, is indicated in patients with liver failure related to TPN. Thus, patients with cirrhosis or advanced fibrosis should receive a combined allograft, while patients with lower grades of liver fibrosis can usually safely undergo ITx. Reflecting their degree of sickness, the waitlist mortality rate and the early posttransplant outcomes of patients receiving L-ITx are worse than IITx. However, L-ITx is associated with better long-term graft and patient survival. Multivisceral transplantation (MVTx), that is, transplantation of the organs dependent on the celiac axis and superior mesenteric artery, can be classified into full MVTx if it includes the liver and modified MVTx if it does not. The most common indications for MVTx are extensive portomesenteric thrombosis and diffuse gastrointestinal pathology such as motility disorders and polyposis syndrome. Every patient with IF should undergo a multidisciplinary evaluation by an experienced ITx team.

Intestinal Transplantation in Pediatric Patients

2002 ◽  
Vol 12 (2) ◽  
pp. 97-115 ◽  
Author(s):  
Beverly Kosmach Park
Keyword(s):  
Medical Management ◽  
Management Strategies ◽  
Intestinal Failure ◽  
Intestinal Transplantation ◽  
Term Survival ◽  
Short Gut Syndrome ◽  
Assessment And Treatment ◽  
Life Threatening ◽  
End Stage ◽  
Intestine Transplantation

Intestine transplantation has evolved into a feasible alternative for children with permanent intestinal failure and life-threatening complications related to total parenteral nutrition. Although the first transplantations were done nearly 40 years ago, long-term survival has only been achieved in the last decade. Nearly 700 intestinal transplantations have been performed internationally since 1985, with an overall patient survival of greater than 50%. Improvements in patient selection, medical management, and assessment and treatment for rejection and infection have contributed to the increased survival. This article will discuss current results and medical management strategies for this innovative type of transplantation for children with end-stage short gut syndrome.

Immunosuppressant Strategies for Intestinal Transplantation: A Review of a Tolerogenic Regimen

2005 ◽  
Vol 15 (1) ◽  
pp. 60-64 ◽  
Author(s):  
Bridget Flynn ◽  
Beverly Kosmach Park ◽  
Geoffrey Bond ◽  
William McGhee ◽  
George Mazariegos ◽  
...  
Keyword(s):  
Intestinal Failure ◽  
Surgical Techniques ◽  
Intestinal Transplantation ◽  
Standard Of Care ◽  
Effective Control ◽  
Term Survival ◽  
Innovative Strategies ◽  
Maintenance Immunosuppression ◽  
Life Threatening

Intestinal, combined liver-intestinal, and multivisceral transplantation are now considered the standard of care for children and adults with permanent intestinal failure. Early attempts at intestinal transplantation were discouraging because of the high incidence of technical complications, rejection, and infection. Advances in the field of transplantation, including the introduction of tacrolimus, improved surgical techniques, and improvements in postoperative care, have led to a renewed interest in intestinal transplantation since 1990. The most significant achievement, however, has been the effective control of rejection and life-threatening infections. This article focuses on the experience to date of innovative strategies that induce lymphocyte depletion and reduction in the incidence of rejection. In this setting, low-maintenance immunosuppression is clinically achievable with an acceptable rate of allograft rejection. Subsequently, the long-term complications of immunosuppression are significantly reduced with achievement of better long-term survival, and an overall improvement in the quality of life.

scholarly journals Is intestinal transplantation now an alternative to home parenteral nutrition?

2007 ◽  
Vol 66 (3) ◽  
pp. 316-320 ◽  
Author(s):  
Stephen J. Middleton
Keyword(s):  
Parenteral Nutrition ◽  
Patient Survival ◽  
Immunosuppressive Agents ◽  
Survival Rates ◽  
Intestinal Failure ◽  
Intestinal Transplantation ◽  
Poor Quality ◽  
Small Intestinal Transplantation ◽  
Small Intestinal ◽  
Intestine Transplantation

Patients with irreversible intestinal failure and complications of parenteral nutrition should now be routinely considered for small intestine transplantation. Despite attempts for >40 years immunological graft intolerance presented an impenetrable barrier to successful engraftment until the development in the late 1970s of the powerful calcineurin-inhibitor immunosuppressive agents. Their use over the last 17 years has led to small intestinal transplantation being generally considered as a routine option for patients with irreversible intestinal failure and failing parenteral nutrition. The 1-year patient survival rates (%) are now excellent for renal (95), liver (78), heart (82) and lung (75) transplantation. In contrast, survival rates for small intestinal transplantation have been slow to improve, although they are now approaching those for lung and liver transplantation (intestine 78%, intestine and liver 60%, multivisceral 66%), and well-performing centres report recent 1-year graft survival rates as high as 92%. Patient 5-year survival (%) has also improved (intestine alone 50, intestine and liver 50 and multivisceral 62) and compares increasingly favourably with renal (85), liver (67), heart (67) and lung (46). Currently, small intestinal transplantation is reserved for patients with irreversible small intestinal failure who have a poor prognosis on parenteral nutrition. However, as 5-year patient survival following intestinal transplantation approaches that for parenteral nutrition there will be increasing pressure to offer this modality of treatment as an alternative to parenteral nutrition, especially for those patients who have a poor quality of life as a result of parenteral nutrition.

Darmtransplantatie: van een experimentele procedure tot een levensreddende behandelingsoptie voor patiënten met gecompliceerd darmfalen

2021 ◽  
Author(s):  
L.J. CEULEMANS ◽  
T. VANUYTSEL ◽  
E. CANOVAI ◽  
M. HIELE ◽  
D. MONBALIU ◽  
...  
Keyword(s):  
Small Bowel Transplantation ◽  
Solid Organ Transplantation ◽  
Intestinal Failure ◽  
Intestinal Transplantation ◽  
Long Term Results ◽  
Solid Organ ◽  
Life Saving ◽  
Life Threatening ◽  
International Data

Bowel transplantation: from an experimental procedure to a life-saving treatment option for patients with complicated bowel failure Intestinal transplantation is the rarest form of solid organ transplantation, probably due to the important immunobiological challenges linked to the procedure, resulting in the need for high levels of immunosuppression and in life-threatening complications like infections, malignancies and renal failure. These factors explain the poor long-term results after small bowel transplantation and the fact that this procedure has always been reserved as the sole life-saving option for patients with severely complicated intestinal failure due to loss of vascular access, infections, or liver failure induced by total parenteral nutrition. In the last decade, an improvement in patient survival and prevention of rejection is observed. This is the result of a better understanding of the immune response and the development of immunomodulatory protocols, like the Leuven protocol, that aims to lower the level of immunosuppression. This review summarizes the current experience and the most recent evolutions in the field of bowel transplantation, describes the Leuven and the Belgian results and compares them to the international data.

scholarly journals Fish Oil Monotherapy for Intestinal Failure-Associated Liver Disease on SMOFlipid in the Neonatal Intensive Care Unit

2020 ◽  
Vol 9 (11) ◽  
pp. 3393
Author(s):  
Sanghoon Lee ◽  
Se In Sung ◽  
Hyo Jung Park ◽  
Yun Sil Chang ◽  
Won Soon Park ◽  
...  
Keyword(s):  
Liver Disease ◽  
Birth Weight ◽  
Fish Oil ◽  
Neonatal Intensive Care ◽  
Lipid Emulsion ◽  
Intestinal Failure ◽  
Direct Bilirubin ◽  
Low Birth Weight Infants ◽  
Life Threatening

Intestinal failure-associated liver disease (IFALD) is a life-threatening complication of parenteral nutrition (PN) and is most prevalent in the preterm neonatal population receiving long-term PN. In this study, we report the outcome of our experience with fish oil monotherapy for IFALD in a fish oil-based combination lipid emulsion administered to preterm low birth weight infants. Fasting neonates were administered as PN according to our center’s nutrition protocol. A diagnosis of IFALD was made when the serum direct bilirubin levels were >2.0 mg/dL in two consecutive measurements that were more than one week apart, without evidence of intrinsic causes of liver dysfunction. The management of IFALD was conducted by switching the lipid emulsion from combination lipid emulsion to fish oil monotherapy at 1.0 g/kg/day, infused over 24 h. Fifteen infants met the criteria for IFALD and received fish oil monotherapy. The median gestational age was 27.5 weeks and the median birth weight was 862.5 g. IFALD was successfully reversed in 11 infants (11/15, 73.3%). The median duration of fish oil monotherapy was 39 days. Direct bilirubin values were initially elevated and then steadily declined from the third week of treatment onward. The enteral tolerance increased in varying degrees during the treatment period. The mean weight gain was 26.0 g/day during fish oil monotherapy. Omegaven® (Fresenius Kabi Austria Gmbh, Graz, Austria) at a dose of 1.0 g/kg/day was well tolerated, and no adverse events related to Omegaven use were seen. The reversal of IFALD in preterm infants on combination lipid emulsion containing fish oil was achieved by switching to fish oil monotherapy.

scholarly journals Liver Disease Secondary to Intestinal Failure

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Bassam Abu-Wasel ◽  
Michele Molinari
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Multidisciplinary Approach ◽  
Intestinal Failure ◽  
Term Survival ◽  
Early Referral ◽  
Long Term Survival ◽  
Threatening Condition ◽  
Life Threatening

IFALD is a common and potentially life-threatening condition for patients with SBS requiring long-term PN. There exists the potential for decreasing its incidence by optimizing the composition and the rate of infusion of parenteral solutions, by advocating a multidisciplinary approach, and by early referral for intestinal-liver transplantation to ensure long-term survival of patients with SBS.

When and How Is it Possible to Stop Therapy in Patients with Lupus Nephritis?

2021 ◽  
pp. CJN.04830421
Author(s):  
Gabriella Moroni ◽  
Giulia Frontini ◽  
Claudio Ponticelli
Keyword(s):  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Kidney Biopsy ◽  
Patient Survival ◽  
Immunosuppressive Agents ◽  
Medical Surveillance ◽  
Complete Clinical Remission ◽  
Life Threatening ◽  
Therapy Withdrawal

Glucocorticoids and other immunosuppressants still represent the cornerstone drugs for the management of SLE (Systemic Lupus Erythematosus) and lupus nephritis. The refined use of these drugs over the years has allowed to obtain stable disease remission and improvement of the long-term kidney and patient survival. Nevertheless, a prolonged use of immunosuppressive agents may be accompanied by severe and even life-threatening side effects. Theoretically, a transient or even definitive withdrawal of immunosuppression could be useful to prevent iatrogenic morbidities. For many years, however, the risk of SLE reactivation has held clinicians back from trying to interrupt therapy. In this review we report the results of the attempts to interrupt glucocorticoids and other immunosuppressive agents in lupus nephritis and in SLE. The available data suggest that the therapy withdrawal is feasible at least in patients enjoying a complete clinical remission after a prolonged therapy. A slow and gradual reduction of treatment under medical surveillance is needed to prevent flares of activity. After therapy withdrawal around one quarter of patients may have kidney or systemic flares. However, most flares may respond to therapy if rapidly diagnosed. The other patients can enter stable remission even for 20 years or more. The use of antimalarials can help in maintaining the remission after the withdrawal of the immunosuppressive therapy. A repeated kidney biopsy could be of help in deciding to stop therapy, but given the few available data, it cannot be considered essential.

Sa1963 Long-Term Patient Survival Rates Can Be Achieved While Receiving Home Parenteral Nutrition for Intestinal Failure

2012 ◽  
Vol 142 (5) ◽  
pp. S-370
Author(s):  
John Siepler ◽  
Reid A. Nishikawa ◽  
Thomas G. Diamantidis ◽  
Rod J. Okamoto
Keyword(s):  
Parenteral Nutrition ◽  
Patient Survival ◽  
Survival Rates ◽  
Intestinal Failure ◽  
Home Parenteral Nutrition

Life-threatening risk factors and the role of intestinal transplantation in patients with intestinal failure

2013 ◽  
Vol 29 (11) ◽  
pp. 1115-1118 ◽  
Author(s):  
Motoshi Wada ◽  
Kotaro Nishi ◽  
Megumi Nakamura ◽  
Hironori Kudo ◽  
Satoshi Yamaki ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intestinal Failure ◽  
Intestinal Transplantation ◽  
Life Threatening

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.

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