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

Author:

Huard Genevieve123ORCID,Schiano Thomas12,Moon Jang1,Iyer Kishore1

Affiliation:

1. Intestinal Rehabilitation and Transplantation Program, Recanati/Miller Transplantation Institute, Mount Sinai Medical Center, New York, NY, USA

2. Division of Liver Diseases, Mount Sinai Medical Center, New York, NY, USA

3. Division of Liver Diseases, Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada

Abstract

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.

Publisher

Hindawi Limited

Subject

Gastroenterology,Hepatology,General Medicine

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1. Chronisches Darmversagen und Darmtransplantation;Springer Reference Medizin;2022

2. Chronisches Darmversagen;Der Chirurg;2021-07-15

3. Intestinal Transplantation for Total Intestinal Aganglionosis;Hirschsprung's Disease and Allied Disorders;2019

4. Identifying the Growth Factors for Improving Neointestinal Regeneration in Rats through Transcriptome Analysis Using RNA-Seq Data;BioMed Research International;2018-12-13

5. Medical Course and Complications After Visceral Transplantation;Psychosocial Care of End-Stage Organ Disease and Transplant Patients;2018-11-23

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