514 results match your criteria Intestinal and Multivisceral Transplantation


Anti-plasma cell treatment in refractory autoimmune hemolytic anemia in a child with multivisceral transplant.

Pediatr Transplant 2021 Jun 6:e14045. Epub 2021 Jun 6.

MedStar Georgetown University Hospital, Transplant Institute, Washington, DC, USA.

Background: Warm-antibody AIHA is known to complicate solid organ (SOT) and HSCT, the disease maybe refractory to standard therapy. Immunosuppressive therapies as well as IVIG, and rituximab have been the main stay of treatment. Over the past decade, B-lymphocyte targeted, anti-CD-20 antibody has been recognized in the treatment of autoimmune diseases and utilized in AIHA. Read More

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Efficacy and Safety of Mammalian Target of Rapamycin Inhibitors Following Intestinal and Multivisceral Transplantation.

Clin Transplant 2021 May 28:e14324. Epub 2021 May 28.

Henry Ford Hospital, Gastroenterology, Detroit, MI, USA.

This is a descriptive study reviewing the outcomes of mammalian target of rapamycin inhibitors (mTORs) in intestinal (IT) and multivisceral transplantation (MVT). This study included 22 patients, 20 adults, and 2 children, and an overall mean age of 46 years old at the time of transplantation. Twelve patients (54. Read More

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Multivisceral Transplantation for Diffuse Portomesenteric Thrombosis: Lessons Learned for Surgical Optimization.

Front Surg 2021 19;8:645302. Epub 2021 Feb 19.

Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, Leuven, Belgium.

Multivisceral transplantation entails the en-bloc transplantation of stomach, duodenum, pancreas, liver and bowel following resection of the native organs. Diffuse portomesenteric thrombosis, defined as the complete occlusion of the portal system, can lead to life-threatening gastrointestinal bleeding, malnutrition and can be associated with liver and intestinal failure. Multivisceral transplantation is the only procedure that offers a definitive solution by completely replacing the portal system. Read More

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February 2021

Intestinal transplantation.

Curr Opin Organ Transplant 2021 Apr;26(2):229-233

Departmetn of Surgery, Liver and Gastrointestinal Transplantation, Miami Transplant Institute, University of Miami/Jackson Memorial Hospital, Miami, Florida, USA.

Purpose Of Review: Intestinal transplantation has evolved to be a viable treatment option for patients with intestinal failure. This review shows the most current tendencies and practices of intestinal transplant centers and an overall comparison to intestinal rehabilitation.

Recent Findings: This review outlines that timing for referral and advances in preoperative and postoperative care of intestinal and multivisceral transplant candidates are crucial to achieve results comparable to intestinal rehabilitation. Read More

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Decline in renal function following intestinal transplant: is the die cast at 3 months?

Clin Transplant 2021 May 24;35(5):e14249. Epub 2021 Feb 24.

Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.

Introduction: This study reports the incidence of chronic kidney disease (CKD) after intestinal transplant (IT) at a single, adult center in the United Kingdom.

Methods: A retrospective review of IT was undertaken. Methods of renal function assessment pre-transplant were compared. Read More

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Using Radiographic Domain for Evaluating Indications in Abdominal Wall Transplantation.

Ann Plast Surg 2021 Feb 3. Epub 2021 Feb 3.

From the Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery Department of Radiology Division of Abdominal Transplant Surgery, Department of Surgery, Duke University Health System, Durham, NC.

Background: There is currently no description of abdominal domain changes in small bowel transplantation population or consensus of criteria regarding which patients are at high risk for immediate postoperative abdominal wall complications or would benefit from abdominal wall vascularized composite allotransplantation.

Methods: A retrospective chart review was performed on 14 adult patients receiving intestinal or multivisceral transplantation. Preoperative and postoperative computed tomography scans were reviewed, and multiple variables were collected regarding abdominal domain and volume and analyzed comparing postoperative changes and abdominal wall complications. Read More

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February 2021

Re-evaluating Blood Markers as Predictors of Outcome in Multivisceral and Intestinal Transplantation.

Transplant Proc 2021 Mar 6;53(2):696-704. Epub 2021 Feb 6.

Department of Pediatrics, Division of Pediatric Infectious Disease and Immunology, University of Miami, Miami, Florida.

Background: Multivisceral transplant (MVTx) and isolated intestinal transplant (ITx) are complex surgical procedures. The subsequent proinflammatory state in the immediate postoperative period makes interpretation of blood markers difficult.

Method: We aimed to establish the course of various blood markers after MVTx/ITx, and to evaluate their use as diagnostic markers of complications. Read More

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Intestinal transplantation: an overview of the recent experimental studies.

Authors:
Mihai Oltean

Curr Opin Organ Transplant 2021 Apr;26(2):240-244

The Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden and Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.

Purpose Of Review: Experimental intestinal transplantation (ITx ) has generated invaluable knowledge that has ultimately benefited the clinical activity. Herein, we appraise the recent publications pertaining to experimental ITx and highlight the main current research topics.

Recent Findings: During the recent years, ischemia-reperfusion injury (IRI) and Graft-versus-host disease (GVHD) have gradually replaced acute rejection as the main research topic. Read More

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Fatal Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis with virus-infected T cells after pediatric multivisceral transplantation: A proof-of-concept case report.

Pediatr Transplant 2021 May 28;25(3):e13961. Epub 2020 Dec 28.

Department of Advanced Medicine for Viral Infections, National Center for Child Health and Development (NCCHD), Tokyo, Japan.

Background: EBV-associated HLH driven by EBV-infected CD8 T cells is a rare complication after pediatric solid organ transplantation. The etiology and disease spectrum of post-transplant EBV-HLH are poorly understood, and making a precise diagnosis and providing optimal treatment remain a challenge.

Methods/case Description/results: We report a 2-year-old multivisceral transplant recipient who developed fever and cytopenia with a persistent high EBV-load state. Read More

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Luminal polyethylene glycol solution delays the onset of preservation injury in the human intestine.

Am J Transplant 2021 Jun 18;21(6):2220-2230. Epub 2021 Jan 18.

The Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.

The organ damage incurred during the cold storage (CS) of intestinal grafts has short and long-term consequences. Animal studies suggest that additional luminal preservation (LP) with polyethylene glycol (PEG) may alleviate this damage. This study aims to validate these findings using human intestines. Read More

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CD69+ resident memory T cells are associated with graft-versus-host disease in intestinal transplantation.

Am J Transplant 2021 05 17;21(5):1878-1892. Epub 2021 Feb 17.

MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital and the Center for Translational Transplant Medicine, Georgetown University Medical Center, Washington, District of Columbia.

Graft-versus-host disease (GvHD) is a common, morbid complication after intestinal transplantation (ITx) with poorly understood pathophysiology. Resident memory T cells (T ) are a recently described CD69+ memory T cell subset localizing to peripheral tissue. We observed that T effector memory cells (T ) in the blood increase during GvHD and hypothesized that they derive from donor graft CD69+T migrating into host blood and tissue. Read More

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Graft assessment for acute rejection after intestinal transplantation: current status and future perspective.

Authors:
Jonas Varkey

Scand J Gastroenterol 2021 Jan 17;56(1):13-19. Epub 2020 Nov 17.

Department of Internal Medicine & Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

Intestinal transplantation has since its inception evolved as a lifesaving treatment option for patients with irreversible intestinal failure who can no longer be sustained on parenteral nutrition. Improvement in short-term survival after transplantation has also justified the expansion of treatment indications. Unfortunately, success is somewhat limited by a plateau observed in long-term survival. Read More

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January 2021

Candidemia Diagnosis With T2 Nuclear Magnetic Resonance in a PICU: A New Approach.

Pediatr Crit Care Med 2021 02;22(2):e109-e114

Clinical Microbiology Department, Hospital La Paz, IdiPaz, Madrid, Spain.

Objectives: Early diagnosis of invasive Candida infections is a challenge for pediatricians, intensivists, and microbiologists. To fill this gap, a new nanodiagnostic method has been developed using manual application of T2 nuclear magnetic resonance to detect Candida species. The aim of this study was to evaluate, prospectively, the usefulness as a tool diagnosis of the T2Candida panel in pediatric patients admitted at the PICU compared with blood culture. Read More

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February 2021

The role of endoscopy in the small intestinal transplant recipient: A review.

Am J Transplant 2021 05 9;21(5):1705-1712. Epub 2020 Dec 9.

Recanati/Miller Transplantation Institute, The Mount Sinai Hospital, New York, New York, USA.

Intestinal transplantation (ITx) is the treatment of choice for patients with intestinal failure who have developed life-threatening complications related to long-term parenteral nutrition. Patients may also undergo ITx as part of a combined liver-intestine or multivisceral transplant for a variety of indications, most commonly intestinal failure-associated liver disease or porto-mesenteric thrombosis. Endoscopy plays a critical role in the posttransplant management of these patients, most commonly in the diagnosis and management of rejection, which occurs in up to 30-40% of patients within the first-year posttransplant. Read More

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Rejection of intestinal allotransplants is driven by memory T helper type 17 immunity and responds to infliximab.

Am J Transplant 2021 03 25;21(3):1238-1254. Epub 2020 Sep 25.

The Center for Translational Transplant Medicine, MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital, Georgetown University Medical Center, Washington, District of Columbia, USA.

Intestinal transplantation (ITx) can be life-saving for patients with advanced intestinal failure experiencing complications of parenteral nutrition. New surgical techniques and conventional immunosuppression have enabled some success, but outcomes post-ITx remain disappointing. Refractory cellular immune responses, immunosuppression-linked infections, and posttransplant malignancies have precluded widespread ITx application. Read More

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Ex Vivo Resection and Autotransplantation for Conventionally Unresectable Tumors - An 11-year Single Center Experience.

Ann Surg 2020 11;272(5):766-772

Center for Liver Disease and Transplantation, Columbia University Medical Center.

Background And Aims: Ex vivo surgery may provide a chance at R0 resection for conventionally unresectable tumors. However, long-term outcomes have not been well documented. In this study, we analyze our 11-year outcomes to define its role. Read More

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November 2020

Operational tolerance in intestinal transplantation.

Am J Transplant 2021 02 30;21(2):876-882. Epub 2020 Aug 30.

Center for Translational Transplant Medicine, MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital, Georgetown University Medical Center, Washington, District of Columbia, USA.

By presenting the first case report of true operational tolerance in an intestinal transplant patient, we aim to demonstrate that tolerance is possible in a field that has been hampered by suboptimal outcomes. Although operational tolerance has been achieved in liver and kidney transplantation, and some intestinal transplant patients have been able to decrease immunosuppression, this is the first instance of true operational tolerance after complete cessation of immunosuppression. A patient received a deceased-donor small intestinal and colon allograft with standard immunosuppressive treatment, achieving excellent graft function after overcoming a graft-versus-host-disease episode 5 months posttransplant. Read More

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February 2021

Type 3 innate lymphoid cells are associated with a successful intestinal transplant.

Am J Transplant 2021 02 21;21(2):787-797. Epub 2020 Jul 21.

Center for Translational Transplant Medicine, Georgetown University Medical Center, MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital, Washington, District of Columbia, USA.

Although innate lymphoid cells (ILCs) play fundamental roles in mucosal barrier functionality and tissue homeostasis, ILC-related mechanisms underlying intestinal barrier function, homeostatic regulation, and graft rejection in intestinal transplantation (ITx) patients have yet to be thoroughly defined. We found protective type 3 NKp44 ILCs (ILC3s) to be significantly diminished in newly transplanted allografts, compared to allografts at 6 months, whereas proinflammatory type 1 NKp44 ILCs (ILC1s) were higher. Moreover, serial immunomonitoring revealed that in healthy allografts, protective ILC3s repopulate by 2-4 weeks postoperatively, but in rejecting allografts they remain diminished. Read More

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February 2021

Complex Abdominal Wound Healing After Multivisceral Retransplant: A Case Report on the Importance of Nutrition.

Transplant Proc 2020 Nov 21;52(9):2839-2843. Epub 2020 Jun 21.

Division of Transplant Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana. Electronic address:

Background: Intestinal transplantation (ITx) is performed as an isolated ITx or as a part of multivisceral transplantation for intestinal failure secondary to short gut syndrome, inflammatory bowel disease, trauma, and sequelae of chronic parenteral nutrition dependence. Wound complications after ITx are very common, and abdominal wound closure cannot be immediately achieved in half of cases.

Case Presentation: A 25-year-old man sustained an abdominal crush injury causing complete loss of his small intestine, requiring an isolated ITx in March 2016. Read More

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November 2020

Living donor liver retransplantation for primary non-function of liver graft following multivisceral transplantation in a pediatric patient.

Ann Hepatobiliary Pancreat Surg 2020 May;24(2):198-202

Division of Pediatric Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Multivisceral organ transplantation (MVOT) includes transplantation of three or more abdominal organs, generally including the small bowel, duodenum, stomach, liver, pancreas, and colon. We here presented the detailed procedures of repeat living donor liver transplantation for primary non-function of the first liver graft following MVOT in a pediatric patient. A 6-year-old girl with chronic intestinal pseudo-obstruction underwent MVOT with 5-year-old donor organs. Read More

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"Stoma or no stoma": First report of intestinal transplantation without stoma.

Am J Transplant 2020 12 23;20(12):3550-3557. Epub 2020 Jun 23.

Department of Surgery, Icahn School of Medicine at Mount Sinai, Recanati Miller Transplantation Institute, New York, New York, USA.

Recent data suggest that frequent endoscopy and biopsy without evidence of graft dysfunction does not appear to confer survival advantage after intestinal transplantation. After abandoning protocol surveillance, endoscopic examination was decreased significantly at our center. These observations led us to question the need for stoma creation in intestinal transplantation. Read More

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December 2020

Beyond 10 years, with or without an intestinal graft: Present and future?

Am J Transplant 2020 10 3;20(10):2802-2812. Epub 2020 May 3.

Department of Pediatric Gastroenterology, Hepatology and Nutrition, Necker-Enfants Malades Hospital, University of Paris, Paris, France.

Long-term outcomes in children undergoing intestinal transplantation remain unclear. Seventy-one children underwent intestinal transplantation in our center from 1989 to 2007. We report on 10-year posttransplant outcomes with (group 1, n = 26) and without (group 2, n = 9) a functional graft. Read More

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October 2020

Use of Nonvascularized Fascia in Liver Transplantation.

Transplant Proc 2020 Jun 21;52(5):1468-1471. Epub 2020 Mar 21.

General Surgery Department. HPB Surgery and Abdominal Organ Transplantation Unit. "Doce de Octubre" University Hospital, Instituto de Investigación (imas12), Complutense University Madrid, Madrid, Spain.

Abdominal wall transplant is developed in the context of intestinal and multivisceral transplant, in which it is often impossible to perform a primary wall closure. Despite the fact that abdominal wall closure is not as consequential in liver transplant, there are circumstances in which it might determine the success of the liver graft, especially in situations that compromise the abdominal cavity and facilitate an abdominal compartment syndrome. CASE 1: A 14-year-old girl suffering from cryptogenic cirrhosis with severe portal hypertension that causes ascites and severe malnutrition. Read More

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Bortezomib for autoimmune hemolytic anemia after intestinal transplantation.

Pediatr Transplant 2020 06 12;24(4):e13700. Epub 2020 Mar 12.

Hematology, University Hospitals Leuven, Leuven, Belgium.

AIHA is rare in the general population and associated with a mortality of 8%. In contrast, AIHA occurs in up to 12.2% of cases after intestinal transplantation and is associated with mortality up to 50%. Read More

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Current state of adult intestinal transplantation in Europe.

Curr Opin Organ Transplant 2020 04;25(2):176-182

Abdominal Transplant Surgery and Transplant Coordination, University Hospitals Leuven; Department of Microbiology, Immunology and Transplantation, KU Leuven.

Purpose Of Review: In Europe, adult intestinal transplantation (ITx) has continuously evolved since the first successful case in 1989. However, despite several recent innovations, no significant improvement in survival has been seen since 2005, illustrating the unique difficulty of transplanting the intestine. In this review, a subanalysis of adult ITx in Europe is discussed and recent publications on adult ITx in Europe are presented. Read More

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Tacrolimus-Induced Optic Neuropathy After Multivisceral Transplantation.

Transplant Direct 2020 Jan 24;6(1):e516. Epub 2019 Dec 24.

Leuven Intestinal Failure and Transplantation center (LIFT), University Hospitals Leuven, Leuven, Belgium.

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January 2020

Long term outcomes of abdominal wall reconstruction using open component separation and biologic mesh in the liver, kidney, and small bowel transplant population.

Hernia 2020 06 24;24(3):469-479. Epub 2020 Jan 24.

Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, USA.

Purpose: The aim of this study is to critically examine the multidisciplinary approach to abdominal wall reconstruction (AWR) in the solid organ transplant (SOT) population at our institution, MedStar Georgetown University Hospital, using a modified component separation technique (CST).

Methods: A retrospective review of AWR utilizing modified open CST with biologic mesh in SOT patients was performed from January 2010 to June 2018. Patient demographics, comorbidities, operative details, complications, and outcomes were recorded. Read More

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