Hostname: page-component-848d4c4894-sjtt6 Total loading time: 0 Render date: 2024-06-30T08:23:10.481Z Has data issue: false hasContentIssue false
  • English
  • Français

Gut failure and abdominal visceral transplantation

Published online by Cambridge University Press:  05 March 2007

Kareem Abu-Elmagd  and
Geoffrey Bond
Kareem Abu-Elmagd*
Affiliation:
Intestinal Rehabilitation and Transplantation Center, Thomas E. Starzl Transplantation Institute, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA
Geoffrey Bond
Affiliation:
Intestinal Rehabilitation and Transplantation Center, Thomas E. Starzl Transplantation Institute, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA
*
*Corresponding author: Dr Kareem Abu-Elmagd, fax +1 412 647 0362, abuelmagdkm@msx.upmc.edu
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Despite the reported high survival with total parenteral nutrition (TPN) therapy for patients with intestinal failure, a considerable number of patients do not escape the potential risks of TPN-associated complications, including hepatic failure, vanishing of central venous access and line sepsis. Thus, intestinal, liver-intestinal and multivisceral transplantation have recently emerged to rescue those who can no longer be maintained on TPN. Before this development, and for nearly three decades, small-bowel transplantation was plagued with uncontrolled rejection, graft v. host disease and fatal infection. These barriers stemmed from the large gut lymphoid mass and heavy microbial load contained in the intestinal lumen. The recent improvement in survival after the clinical introduction of tacrolimus with achievement of full enteric nutritional autonomy qualified the procedure by the US Health Care Financing Administration as the standard of care for patients with intestinal and TPN failure. The decision was supported by a decade of clinical experience with cumulative improvement in patient and graft survival. In addition, the introduction of new effective immunoprophylactic agents and novel therapeutic approaches has contributed to a further increase in the therapeutic advantages of the procedure. The present review article outlines the current clinical practice of intestinal transplantation and defines new management strategies with the aim of raising the level of the procedure to be a better alternative therapy for TPN-dependent patients.

Keywords

Intestinal failureTotal parenteral nutritionAbdominal visceral transplantationIntestinal transplantation and gut failure
Type
Meeting Report
Information
Proceedings of the Nutrition Society , Volume 62 , Issue 3 , August 2003 , pp. 727 - 737
Copyright
Copyright © The Nutrition Society 2003

References

Abu-Elmagd, K, Bond, G, Reyes, J & Fung, J (2002 a) Intestinal transplantation: A coming of age. Advances in Surgery 36, 65–101.Google ScholarPubMed
Abu-Elmagd, K, Fung, J, Bueno, J, Martin, D, Madariaga, JR, Mazariegos, G, Bond, G, Molmenti, E, Corry, RJ, Starzl, TE & Reyes, J (2000 a) Logistics and technique for procurement of intestinal, pancreatic, and hepatic grafts from the same donor Annals of Surgery 232, 680–687.CrossRefGoogle ScholarPubMed
Abu-Elmagd, K, Fung, JJ, McGhee, W, Martin, D, Mazariegos, G, Schaefer, N, Demetris, J, Starzl, TE & Reyes, J (2000 b) The efficacy of daclizumab for intestinal transplantation: Preliminary report Transplantation Proceedings 32, 1195–1196.CrossRefGoogle ScholarPubMed
Abu-Elmagd, K, Fung, JJ, Reyes, J, Casavilla, A, Van Thiel, DH, Iwaki, Y, Warty, V, Nikolaidis, N, Block, J, Nakamura, K, Goldbach, B, Demetris, A, Tzakis, AG, Todo, S & Starzl, TE (1992) Management of intestinal transplantation in humans Transplantation Proceedings 24, 1243–1244.Google ScholarPubMed
Abu-Elmagd, K, Reyes, J, Bond, G, Mazariegos, G, Wu, T, Murase, N et al. (2001) Clinical intestinal transportation: A decade of a single center experience. Annals of Surgery 234, 404–417.CrossRefGoogle Scholar
Abu-Elmagd, K, Reyes, J, Fung, JJ, Mazariegos, G, Bueno, J, Janov, C, Colangelo, J, Rao, A, Demetris, A & Starzl, TE (1999) Evolution of clinical intestinal transplantation: Improved outcome and cost effectiveness. Transplantation Proceedings 31, 582–584.CrossRefGoogle ScholarPubMed
Abu-Elmagd, K, Reyes, J, Todo, S, Rao, A, Lee, R, Irish, W, Furukaw, H, Bueno, J McMichael, J, Fawzy, AT, Murase, N, Demetris, J, Rakela, J, Fung, JJ & Starzl, TE (1998) Clinical intestinal transplantation: New perspectives and immunologic considerations. Journal of the American College of Surgeons 186, 512–527.CrossRefGoogle ScholarPubMed
Abu-Elmagd, K, Todo, S, Tzakis, A, Reyes, J, Nour, B, Furukawa, H, Fung, JJ, Demetris, A & Starzl, TE (1994) Three years clinical experience with intestinal transplantation. Journal of the American College of Surgeons 179, 385–400.Google ScholarPubMed
Abu-Elmagd, KM, Bond, GJ, Murase, N, Demetris, A, Wu, T, Reyes, J, Fung, J, Starzl, T (2002 b) Induction therapy, graft immunomodulation, and tolerance enhancing strategy for intestinal transplantation. Transplantation> 74, 218.Google Scholar
Bond, G, Reyes, J, Mazariegos, G, Wu, T, Schaefer, N, Demetris, J, Fung, JJ, Starzl, TE, Abu-Elmagd, K (2000) The impact of positive T-cell lymphocytotoxic cross-match on intestinal allograft rejection and survival. Transplantation Proceedings 32, 1197–1198.CrossRefGoogle Scholar
Bueno, J, Ohwada, S, Kocoshis, S, Mazariegos, GV, Dvorchik, I, Sigurdsson, L, Di Lorenzo, C, Abu-Elmagd, K & Reyes, J (1999) Factors impacting on the survival of children. Intestinal failure referred for intestinal transplantation. Journal of Pediatric Surgery 34, 27–33.CrossRefGoogle ScholarPubMed
Giraldo, M, Martin, D, Colangelo, J, Bueno, J, Reyes, J, Fung, JJ, Starzl, TE & Abu-Elmagd, K (2000) Intestinal transplantation for patients with short gut syndrome and hypercoagulable states. Transplantation Proceedings 32, 1223–1224.CrossRefGoogle ScholarPubMed
Grant, D (1999) Intestinal transplantation: 1997 Report of the International Registry. Transplantation 67, 1061–1064.CrossRefGoogle ScholarPubMed
Grant, D (2001) Report of the International Intestinal Transplant Registry. http//:www.lhsc.on.ca/itr.Google Scholar
Horslen, SP, Kaurman, SS, Sudan, DL, Fox, IJ, Shaw, BW & Langnas, AN (2000) Isolated liver transplantation in infants with total parenteral nutrition-associated end-stage liver disease. Transplantation Proceedings 32, 1241–1244.CrossRefGoogle ScholarPubMed
Howard, L & Hassan, N (1998) Home parenteral nutrition: 25 years later. Clinical Nutrition 27, 481–512.Google ScholarPubMed
Idoate, MA, Martinez, AJ, Bueno, J, Abu-Elmagd, K & Reyes, J (1999) The neuropathology of intestinal failure and small bowel transplantation. Acta Neuropathologica 97, 502–508.CrossRefGoogle ScholarPubMed
Kato, T, O'Brien, CB, Berho, M, Nishida, S, Levi, D, Khan, FA, Pinna, AD, Nery, JR, Ruiz, P & Tzakis, AG (2000) Improved rejection surveillance in intestinal transplant recipients with frequent use of zoom video endoscopy. Transplantation Proceedings 32, 1200–1203.CrossRefGoogle ScholarPubMed
Lawrence, JP, Dunn, SP, Billmire, DE, Falkenstein, K, Vinocur, CD & Weintraub, WH (1994) Isolated liver transplantation for liver failure in patients with short bowel syndrome. Journal of Pediatric Surgery 29, 751–753.CrossRefGoogle ScholarPubMed
Lee, RG, Nakamura, K, Tsamandas, AC, Abu-Elmagd, K, Furukawa, H, Hutson, WR, Reyes, J, Tabasco-Minguillan, JS, Todo, S & Demetris, AJ (1996) Pathology of human intestinal transplantation (comments). Gastroenterology 110, 2009–2012.CrossRefGoogle Scholar
Messing, B, Crenn, P, Beau, P, Boutron-Ruault, MC, Rambaud, JC & Matuchansky, C (1999) Long-term survival and parenteral nutrition dependence in adult patients with the short bowel syndrome. Gastroenterology 117, 1043–1050.CrossRefGoogle ScholarPubMed
Murase, N, Starzl, TE, Tanabe, M, Fujisaki, S, Miyazawa, H, Ye, Q, Delaney, CP, Fung, JJ & Demetris, AJ (1995) Variable chimerism, graft versus host disease, and tolerance after different kinds of cell and whole organ transplantation from Lewis to Brown-Norway rats. Transplantation 60, 158–171.CrossRefGoogle Scholar
Murase, N, Ye, Q, Nalesnik, MA, Demetris, AJ, Abu-Elmagd, K, Reyes, J, Ichikawa, N, Okuda, T, Fung, JJ & Starzl, TE (2000) Immunomodulation for intestinal transplantation by allograft irradiation, adjunct donor bone marrow infusion, or both. Transplantation 70, 1632–1641.CrossRefGoogle ScholarPubMed
Pappas, PA, Saudubray, JM, Tzakis, AG, Rabier, D, Carreno, MR, Gomez-Marin, O, Huijing, F, Gelman, B, Levi, DM, Nery, JR, Kato, T, Mittal, N, Nishida, S, Thompson, JF & Ruiz, P (2001) Serum citrulline and rejection in small bowel transplantation: a preliminary report. Transplantation 72, 1212–1216.CrossRefGoogle ScholarPubMed
Reyes, J, Tzakis, AG, Todo, S, Nour, B, Casavilla, A Abu-Elmagd, K, Fung, JJ & Starzl, TE (1993) Nutritional management of intestinal transplant recipients. Transplantation Proceedings 25, 1200–1201.Google ScholarPubMed
Starzl, TE, Demetris, AJ, Murase, N, Ildstad, S, Ricordi, C & Trucco, M (1992) Cell migration, chimerism, and graft acceptance. Lancet 339, 1579–1582.CrossRefGoogle ScholarPubMed
Starzl, TE & Zinkernagel, R (1998) Antigen localization and migration in immunity and tolerance New England Journal of Medicine 339, 1905–1913.CrossRefGoogle ScholarPubMed
Starzl, TE, Zinkernagel, RM (2001) Transplantation tolerance from an historical perspective. Nature Reviews Immunology 1, 1–7.CrossRefGoogle ScholarPubMed
Todo, S, Reyes, J, Furukawa, H, Abu-Elmagd, K, Lee, RG, Tzakis, A, Rao, AS & Starzl, TE (1995 a) Outcome analysis of 71 clinical intestinal transplantation Annals of Surgery 222, 270–282.CrossRefGoogle Scholar
Todo, S, Tzakis, A, Abu-Elmagd, K, Reyes, J, Furukawa, H, Nour, B, Fung, J, Demetris, A & Starzl, TE (1995 b) Abdominal multi-visceral transplantation Transplantation 59, 234–240.CrossRefGoogle Scholar
Todo, S, Tzakis, AG, Abu-Elmagd, K, Reyes, J, Nakamura, K, Casavilla, A, Selby, R, Nour, BM, Wright, H, Fung, JJ et al. (1992) Intestinal transplantation in composite visceral grafts or alone Annals of Surgery 216, 223–234.CrossRefGoogle ScholarPubMed