491 results match your criteria Intestinal and Multivisceral Transplantation


Immunosuppression in Visceral Transplantation: Current Trends and Future Perspectives.

Curr Pharm Des 2020 Jul 7. Epub 2020 Jul 7.

Miami Transplant Institute, University of Miami/Jackson Memorial Hospital, Miami, Fl. United States.

Visceral transplant represents an immunologic challenge due to high intestinal graft immunogenicity. Over the last 20 years, significant advances in immunosuppression regimens resulted in excellent short term outcomes. Currently, visceral transplant is the standard of care for patients with gut failure with life-threatening complications and complex abdominal pathology. Read More

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http://dx.doi.org/10.2174/1381612826666200707131857DOI Listing

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

Transplant Proc 2020 Jun 20. Epub 2020 Jun 20.

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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http://dx.doi.org/10.1016/j.transproceed.2020.05.026DOI Listing

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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http://dx.doi.org/10.14701/ahbps.2020.24.2.198DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7271102PMC

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

Am J Transplant 2020 May 20. Epub 2020 May 20.

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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http://dx.doi.org/10.1111/ajt.16065DOI Listing

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

Am J Transplant 2020 Apr 10. Epub 2020 Apr 10.

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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http://dx.doi.org/10.1111/ajt.15899DOI Listing

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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http://dx.doi.org/10.1016/j.transproceed.2020.01.081DOI Listing

Bortezomib for autoimmune hemolytic anemia after intestinal transplantation.

Pediatr Transplant 2020 Jun 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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http://dx.doi.org/10.1111/petr.13700DOI Listing

Current state of adult intestinal transplantation in Europe.

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

Abdominal Transplant Surgery and Transplant Coordination, University Hospitals 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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http://dx.doi.org/10.1097/MOT.0000000000000731DOI Listing

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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http://dx.doi.org/10.1097/TXD.0000000000000960DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6964932PMC
January 2020

Familial Adenomatous Polyposis and Desmoid Tumor Treated with Multivisceral Transplantation and Kidney Autotransplantation: Case Report and Literature Review.

Case Rep Surg 2019 22;2019:6064720. Epub 2019 Dec 22.

Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.

Introduction: Desmoid tumours (DT) are commonly associated with Gardener's syndrome. Their surgical resection may be complicated by their close proximity to major vessels, multiple organ involvement, and frequent local recurrence. Multivisceral transplantation (MVTx) is an alternative treatment for patients with intestinal and liver failure. Read More

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http://dx.doi.org/10.1155/2019/6064720DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6942762PMC
December 2019

Association of Alemtuzumab Induction With a Significantly Lower Incidence of GVHD Following Intestinal Transplantation: Results of 445 Consecutive Cases From a Single Center.

Transplantation 2020 Jan 3. Epub 2020 Jan 3.

Miami Transplant Institute, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.

Background: In intestinal transplantation, graft versus host disease(GVHD), while relatively rare, remains as a major cause of morbidity and mortality posttransplant. Due to its rarity of occurrence, no multivariable analysis of risk factors for GVHD development has previously been reported.

Methods: We used Cox stepwise regression to determine the significant multivariable predictors of the hazard rate of developing biopsy-proven GVHD during the first 60mo posttransplant among 445 consecutive intestinal transplant cases at our center since 1994. Read More

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http://dx.doi.org/10.1097/TP.0000000000003111DOI Listing
January 2020

Clostridium difficile infection mimics intestinal acute cellular rejection in pediatric multivisceral transplant-A case series.

Pediatr Transplant 2020 02 9;24(1):e13621. Epub 2019 Dec 9.

Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Miami, Miami, FL, USA.

Clostridium difficile infection (CDI) is the most common health care-associated infection in the United States. Thirty-nine percent of intestinal transplant recipients may develop CDI. Induction of rejection has been reported as a rare event. Read More

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http://dx.doi.org/10.1111/petr.13621DOI Listing
February 2020
7 Reads

Intra-abdominal infections among adult intestinal and multivisceral transplant recipients in the 2-year post-operative period.

Transpl Infect Dis 2020 Feb 13;22(1):e13219. Epub 2019 Dec 13.

Division of Infectious Diseases and Travel Medicine, Department of Medicine, Georgetown University, Washington, District of Columbia.

Background: Intestinal and multivisceral transplantations are treatment options for patients with intestinal failure. Transplantation is often complicated by abdominal and/or bloodstream infections in the post-operative period.

Methods: A retrospective chart review of all adults who underwent intestinal or multivisceral transplantation at our institution from 2003 to 2015 was performed. Read More

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http://dx.doi.org/10.1111/tid.13219DOI Listing
February 2020

Hepatobiliary Complications of Chronic Intestinal Failure.

Gastroenterol Clin North Am 2019 12 4;48(4):551-564. Epub 2019 Oct 4.

Department of Pathology, Institut Bordet, rue Heger Bordet, 1-1000 Brussels, Belgium.

Intestinal failure-associated liver disease is a multifactorial process that may occur in patients with chronic intestinal failure on long-term home parenteral nutrition. A very short gut, the lack of enteral feeding, recurrent sepsis, and parenteral overfeeding are major risk factors. Histologic changes include steatosis, steatohepatitis, cholestasis, fibrosis, and cirrhosis. Read More

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http://dx.doi.org/10.1016/j.gtc.2019.08.008DOI Listing
December 2019

Use of pediatric donor en bloc kidneys along with bladder segment in pediatric liver-kidney and multivisceral-kidney transplantation.

Pediatr Transplant 2020 02 11;24(1):e13596. Epub 2019 Oct 11.

Department of Surgery, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, USA.

The combination of pediatric multivisceral and kidney transplantation leads to additional recipient risks due to the number of anastomoses and to the small sizes of donor structures. The inclusion of donor kidneys, ureters, and a bladder patch en bloc with multivisceral organs decreases the number and complexity of anastomoses and has not yet been reported. Four patients were transplanted in this fashion; three underwent multivisceral-kidney and one underwent liver-kidney transplantation. Read More

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http://dx.doi.org/10.1111/petr.13596DOI Listing
February 2020
4 Reads
1.630 Impact Factor

Cavoportal Hemitransposition in Liver Transplantation: Toward a More Safe and Efficient Technique.

Liver Transpl 2020 01 22;26(1):92-99. Epub 2019 Nov 22.

University Pittsburgh Medical Center-Italy, Istituto Mediterraneo for Trapianto e Terapie ad Alta Specializzazione, Istituto di Ricovero e Cura a Carattere Scientifico, Palermo, Italy.

Extended splanchnic venous thrombosis represents a challenge for the liver transplantation (LT) surgeon. In the absence of large venous tributaries, the cavoportal hemitransposition (CPHTr) and the combined liver-intestinal or multivisceral transplantation are the only technical solutions. Because of the reported high morbidity and mortality rates due to infrequent use and a lack of standardization, the former technique has been almost abandoned by the transplant community. Read More

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http://dx.doi.org/10.1002/lt.25635DOI Listing
January 2020
2 Reads

Review article: diagnosis and management of intestinal failure-associated liver disease in adults.

Aliment Pharmacol Ther 2019 09 25;50(6):640-653. Epub 2019 Jul 25.

Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Salford, UK.

Background: Hepatic disturbances in the context of intestinal failure and parenteral nutrition (PN) are frequently encountered and carry a significant burden of morbidity and sometimes mortality. The term intestinal failure-associated liver disease (IFALD) refers to liver injury due to intestinal failure and associated PN, in the absence of another evident cause of liver disease, encompassing a spectrum of conditions from deranged liver enzymes, steatosis/ steatohepatitis, cholestasis as well as progressive fibrosis, cirrhosis and end-stage liver disease.

Aims: To present an up to date perspective on the diagnosis/definition, aetiologies and subsequent management of IFALD and to explore future consideration for the condition, including pharmacological therapies RESULTS: In adults using long-term PN for benign chronic intestinal failure, 1%-4% of all deaths are attributed to IFALD. Read More

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http://dx.doi.org/10.1111/apt.15432DOI Listing
September 2019
8 Reads

Ileostomy After Intestinal Transplantation: The First in Depth Report on Techniques, Complications, and Outcomes.

Transplantation 2020 Mar;104(3):652-658

The Dumont UCLA Transplant Center, Division of Liver and Pancreas transplantation, Department of Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA.

Background: Temporary ileostomy during intestinal transplantation (ITx) is the standard technique for allograft monitoring. A detailed analysis of the ITx ileostomy has never been reported.

Methods: A retrospective review of a single-center ITx database was performed. Read More

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http://dx.doi.org/10.1097/TP.0000000000002879DOI Listing
March 2020
3 Reads

Clostridium difficile: A Frequent Infection in Children After Intestinal Transplantation.

Transplantation 2020 Jan;104(1):197-200

Hôpital Necker-Enfants Malades Assistance Publique-Hôpitaux de Paris, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Université Paris Descartes - Sorbonne Paris Cité, Paris, France.

Background: Organ transplantation (Tx) is a risk factor for Clostridium difficile infection (CDI). After intestinal transplantation (ITx), few data are available on the impact of this graft infection and the possible induction of rejection.

Methods: We included retrospectively all children after ITx in our unit, with at least 1 year of graft survival. Read More

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http://Insights.ovid.com/crossref?an=00007890-900000000-9608
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http://dx.doi.org/10.1097/TP.0000000000002795DOI Listing
January 2020
24 Reads

The difficult abdominal closure after paediatric intestinal transplantation: Use of abdominal rectus muscle fascia and literature review.

Pediatr Transplant 2019 08 24;23(5):e13473. Epub 2019 May 24.

Institute of Liver Studies, King's Healthcare Partners Denmark Hill Site, London, UK.

Primary abdominal wall closure after intestinal and multivisceral transplantation may not be possible because of loss of abdominal domain and/or graft size/abdominal cavity mismatch. Traditional closure techniques for the open abdomen may not be valid in these circumstances because of severe scarring of the abdominal wall from multiple previous surgeries in this particular group of patients. We present our initial experience with the use of non-vascularized abdominal rectus muscle fascia in two patients who underwent deceased donation and living-related combined liver and small bowel transplantation, respectively, and who could not be closed primarily. Read More

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http://dx.doi.org/10.1111/petr.13473DOI Listing
August 2019
8 Reads

Fibrinolytic Shutdown Is Associated With Intraoperative Thrombosis and Hemorrhage During Visceral Transplant.

Semin Cardiothorac Vasc Anesth 2019 Sep 8;23(3):300-308. Epub 2019 May 8.

1 University of Miami/Jackson Memorial Hospital, Miami, FL, USA.

. End-stage liver disease is characterized by a precarious imbalance of hemostasis. Detrimental consequences of hypofibrinolysis, also known as fibrinolytic shutdown, have been recently demonstrated, and its significance in visceral (ie, an allograft that contains the intestine) transplant remains unknown. Read More

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http://dx.doi.org/10.1177/1089253219848441DOI Listing
September 2019
5 Reads

Abdominal wall transplantation in organ transplantation: Our experience.

Cir Esp 2019 May 1;97(5):247-253. Epub 2019 Apr 1.

Servicio de Cirugía General y del Aparato Digestivo, Unidad de Cirugía Hepatobiliopancreática y Trasplante de Órganos Abdominales, Hospital Universitario Doce de Octubre, Madrid, España; Instituto de Investigación (Imas12), Departamento de Cirugía, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España.

Abdominal wall transplantation has been consolidated as an alternative to primary abdominal wall closure in intestinal and multiple organ transplant recipients. Given that it is feasible to obtain the visceral graft and the abdominal wall graft from the same donor, abdominal wall transplantation could offer satisfactory outcomes and be easily coordinated. Non-vascularized fascia is one of the alternatives for abdominal wall closure in transplantation. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S0009739X193007
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http://dx.doi.org/10.1016/j.ciresp.2019.03.002DOI Listing
May 2019
29 Reads

Long-term outcomes of ultrashort bowel syndrome due to malrotation with midgut volvulus managed at an interdisciplinary pediatric intestinal rehabilitation center.

J Pediatr Surg 2019 May 2;54(5):964-967. Epub 2019 Feb 2.

Center for Advanced Intestinal Rehabilitation, Department of Surgery; Boston Children's Hospital and Harvard Medical School, Boston, MA, USA. Electronic address:

Purpose: The purpose of this study was to describe long-term outcomes of pediatric-onset ultrashort bowel syndrome owing to midgut volvulus managed at an interdisciplinary intestinal rehabilitation center.

Methods: Patients with a history of malrotation and pediatric-onset midgut volvulus causing extensive bowel loss (<20% residual small bowel length expected for postconception age) and treated between 2010 and 2017 were reviewed. Data are expressed as median (IQR). Read More

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http://dx.doi.org/10.1016/j.jpedsurg.2019.01.025DOI Listing
May 2019
12 Reads

Update on Chronic Rejection After Intestinal Transplant: An Overview From Experimental Settings to Clinical Outcomes.

Exp Clin Transplant 2019 01;17(Suppl 1):18-30

From the St. Orsola University Hospital Alma Mater Studiorum, Bologna, Italy.

Chronic rejection affects the long-term survival of solid-organ transplants, accounting for an incidence of between 5% and 10% after intestinal/multivisceral transplant. Because of unclear symptoms and signs and endoscopic findings, the diagnosis is often delayed. Presently, allograft removal represents the only available therapy due to the absence of effective pharmacologic approaches. Read More

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http://www.ectrx.org/forms/ectrxcontentshow.php?doi_id=10.60
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http://dx.doi.org/10.6002/ect.MESOT2018.L32DOI Listing
January 2019
29 Reads

Current status of graft-versus-host disease after intestinal transplantation.

Curr Opin Organ Transplant 2019 04;24(2):199-206

Division of Pediatric Transplantation, Department of Surgery, Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, Thomas E. Starzl Transplant Institute, University of Pittsburgh School of Medicine, Pittsburgh, USA.

Purpose Of Review: Over the past decades, visceral transplantation has become the standard of care for patients with irreversible intestinal failure who suffer complications of total parenteral nutrition (TPN). Graft-versus-host disease (GVHD) after solid organ transplantation is a rare but often fatal complication with high mortality. GVHD after intestinal transplantation, given the large lymphoid content of the graft, is more frequent compared with other solid organs. Read More

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http://dx.doi.org/10.1097/MOT.0000000000000624DOI Listing
April 2019
49 Reads

Long-term survival in visceral transplant recipients in the new era: A single-center experience.

Am J Transplant 2019 07 26;19(7):2077-2091. Epub 2019 Mar 26.

MedStar Georgetown Transplant Institute, Georgetown University Hospital, Washington, District of Columbia.

There is a paucity of data on long-term outcomes following visceral transplantation in the contemporary era. This is a single-center retrospective analysis of all visceral allograft recipients who underwent transplant between November 2003 and December 2013 with at least 3-year follow-up data. Clinical data from a prospectively maintained database were used to assess outcomes including patient and graft survival. Read More

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http://dx.doi.org/10.1111/ajt.15269DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6591067PMC
July 2019
11 Reads

Composite and Multivisceral Transplantation: Nomenclature, Surgical Techniques, Current Practice, and Long-term Outcome.

Surg Clin North Am 2019 Feb;99(1):129-151

Center for Gut Rehabilitation and Transplantation, Cleveland Clinic, 9500 Euclid Avenue, Desk A100, Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Avenue, Desk A100, Cleveland, OH 44195, USA. Electronic address:

The successful development of multivisceral and composite visceral transplantation is among the milestones in the recent history of human organ transplantation. All types of gastrointestinal transplantation have evolved to be the standard of care for patients with gut failure and complex abdominal pathologic conditions. The outcome has markedly improved over the last 3 decades owing to technical innovation, novel immunosuppression, and better postoperative care. Read More

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http://dx.doi.org/10.1016/j.suc.2018.09.010DOI Listing
February 2019
25 Reads

Small Bowel Transplantation.

Surg Clin North Am 2019 Feb;99(1):103-116

Division of Abdominal Transplant Surgery, Duke University Medical Center, DUMC Box 3522, Durham, NC 27710, USA. Electronic address:

Intestinal and multivisceral transplants are complex technical procedures that present unique challenges in the field of solid organ transplantation. This review aims to highlight the indications, techniques, outcomes, and complications specific to intestinal transplantation. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S00396109183013
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http://dx.doi.org/10.1016/j.suc.2018.09.008DOI Listing
February 2019
38 Reads

Surgeon's perspective on short bowel syndrome: Where are we?

World J Transplant 2018 Oct;8(6):198-202

Liver and Multiorgan Transplant Unit, St. Orsola-Malpighi University Hospital, Bologna 40138, Italy.

Short bowel syndrome (SBS) is due to a massive loss of small bowel: the reduction of gut function is below the minimum necessary to maintain health (in adults) and growth (in children) so intravenous supplementation is required. Parenteral nutrition represents the milestone of treatment and surgical attempts should be limited only when the residual bowel is sufficient to increase absorption, reducing diarrhea and slowing the transit time of nutrients, water and electrolytes. The surgical techniques lengthen the bowel (tapering it) or reverse a segment of it: developed in children, nowadays are popular also among adults. Read More

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http://dx.doi.org/10.5500/wjt.v8.i6.198DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6201325PMC
October 2018
46 Reads

Post-intestine transplant graft-vs-host disease associated with inclusion of a liver graft and with a high mortality risk.

Clin Transplant 2019 01 5;33(1):e13409. Epub 2018 Dec 5.

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

Introduction: This study reports the incidence, anatomic location, and outcomes of graft-vs-host disease (GVHD) at a single active intestine transplant center.

Methods: Records were reviewed for all patients receiving an intestine transplant from 2003 to 2015. Pathology reports and pharmacy records were reviewed to establish the diagnosis, location, and therapeutic interventions for GVHD. Read More

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http://doi.wiley.com/10.1111/ctr.13409
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http://dx.doi.org/10.1111/ctr.13409DOI Listing
January 2019
7 Reads

Donor-Specific Antibodies in Pediatric Intestinal and Multivisceral Transplantation: The Role of Liver and Human Leukocyte Antigen Mismatching.

Liver Transpl 2018 12;24(12):1726-1735

Department of Immunology, University Hospital 12 de Octubre, Madrid, Spain.

Rejection is one of the most important drawbacks for graft and patient survival in intestinal and multivisceral transplantation. However, there is no consensus on the diagnostic criteria for humoral rejection, and the literature about the role of donor-specific antibodies (DSA) on allograft outcome and the risk factors that contribute to their development is scant with contradictory results. The present study analyzes the role of DSA exclusively in a pediatric cohort of 43 transplants. Read More

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http://dx.doi.org/10.1002/lt.25323DOI Listing
December 2018
33 Reads

The Impact of an Advanced ECMO Program on Traumatically Injured Patients.

Artif Organs 2018 Nov 24;42(11):1043-1051. Epub 2018 Jul 24.

Dewitt Daughtry Family Department of Surgery, Division of Cardiothoracic Surgery, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, USA.

In June 2016, an advanced extracorporeal membrane oxygenation (ECMO) program consisting of a multidisciplinary team was initiated at a large level-one trauma center. The program was created to standardize management for patients with a wide variety of pathologies, including trauma. This study evaluated the impact of the advanced ECMO program on the outcomes of traumatically injured patients undergoing ECMO. Read More

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http://dx.doi.org/10.1111/aor.13152DOI Listing
November 2018
56 Reads

Fatal breakthrough mucormycosis in a multivisceral transplant patient receiving micafungin: Case report and literature review.

IDCases 2018 24;12:76-79. Epub 2018 Mar 24.

Clinical Microbiology & Public Health Laboratory, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.

Introduction: Antifungal agents are routinely used in the post-transplant setting for both prophylaxis and treatment of presumed and proven fungal infections. Micafungin is an echinocandin-class antifungal with broad antifungal cover and favorable side effect profile but, notably, it has no activity against molds of the order Mucorales.

Presentation Of Case: A 47-year-old woman underwent multivisceral transplantation for intestinal failure-associated liver disease. Read More

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http://dx.doi.org/10.1016/j.idcr.2018.03.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6010962PMC
March 2018
18 Reads

Fecal pancreatic elastase-1 in the evaluation of pancreatic function after pediatric intestinal transplantation.

Pediatr Transplant 2018 Jun 21:e13247. Epub 2018 Jun 21.

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

Fat malabsorption is common after SBT. To identify whether anatomic variant transplants differ in occurrence of exocrine pancreatic insufficiency that could contribute to fat malabsorption, we measured FPE repeatedly in 54 recipients of a SBT, ages 6.2 to 320 months. Read More

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http://dx.doi.org/10.1111/petr.13247DOI Listing
June 2018
43 Reads

Thrombotic and hemorrhagic complications during visceral transplantation: risk factors, and association with intraoperative disseminated intravascular coagulation-like thromboelastographic qualities: a single-center retrospective study.

Transpl Int 2018 10 5;31(10):1125-1134. Epub 2018 Jun 5.

Department of Anesthesia, Jackson Memorial Hospital, University of Miami, Miami, FL, USA.

This study describes the risk of thrombotic and hemorrhagic complications, both intraoperatively, and up to 1 month following visceral transplantation. Data from 48 adult visceral transplants performed between 2010 and 2017 were retrospectively studied [32 multivisceral (MVTx); 10 isolated intestine; six modified-MVTx]. Intraoperatively, intracardiac thrombosis (ICT)/pulmonary embolism (PE) occurred in 25%, 0% and 0% of MVTx, isolated intestine and modified MVTx, respectively, and was associated with 50% (4/8) mortality. Read More

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http://doi.wiley.com/10.1111/tri.13281
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http://dx.doi.org/10.1111/tri.13281DOI Listing
October 2018
52 Reads

Comparable outcomes in intestinal retransplantation: Single-center cohort study.

Clin Transplant 2018 07 12;32(7):e13290. Epub 2018 Jun 12.

Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.

Background: Graft loss in intestinal transplantation (ITx) is close to 25% in the first year and 50% at 5-year post-transplantation. Although technically and immunologically challenging, intestinal retransplantation is now the 4th most common indication for ITx.

Methods: The aim of this study was to review and compare the outcomes of intestinal retransplantation with primary ITx, which included isolated ITx, modified multivisceral transplantation (mMVTx), and full MVTx, between 2003 and 2014 at Indiana University. Read More

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http://dx.doi.org/10.1111/ctr.13290DOI Listing
July 2018
23 Reads

Intestinal transplants: review of normal imaging appearance and complications.

Br J Radiol 2018 Oct 5;91(1090):20180173. Epub 2018 Jun 5.

1 Department of Radiology, Henry Ford Hospital , Detroit, MI , USA.

Intestinal transplant (IT) is one of the least common forms of organ transplant but is increasing both in volume of cases and number of centers performing intestinal transplants, with the busiest centers in North America and Europe. IT can be performed in isolation or as part of a multivisceral transplant (MVT). Intestinal failure either in the form of short gut syndrome or functional bowel problems is the primary indication for IT. Read More

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https://www.birpublications.org/doi/10.1259/bjr.20180173
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http://dx.doi.org/10.1259/bjr.20180173DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6350467PMC
October 2018
28 Reads

Composite and Multivisceral Transplantation: Nomenclature, Surgical Techniques, Current Practice, and Long-term Outcome.

Gastroenterol Clin North Am 2018 Jun;47(2):393-415

Center for Gut Rehabilitation and Transplantation, Cleveland Clinic, 9500 Euclid Avenue, Desk A100, Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Avenue, Desk A100, Cleveland, OH 44195, USA. Electronic address:

The successful development of multivisceral and composite visceral transplantation is among the milestones in the recent history of human organ transplantation. All types of gastrointestinal transplantation have evolved to be the standard of care for patients with gut failure and complex abdominal pathologic conditions. The outcome has markedly improved over the last 3 decades owing to technical innovation, novel immunosuppression, and better postoperative care. Read More

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http://dx.doi.org/10.1016/j.gtc.2018.01.013DOI Listing
June 2018
14 Reads

Total pancreaticoduodenectomy with autologous islet transplantation 14 years after liver-contained composite visceral transplantation.

Am J Transplant 2018 08 14;18(8):2068-2074. Epub 2018 May 14.

Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.

Chronic pancreatitis (CP) is a severely disabling disorder with potential detrimental effects on quality of life, gut function, and glucose homeostasis. Disease progression often results in irreversible morphological and functional abnormalities with development of chronic pain, mechanical obstruction, and pancreatic insufficiency. Along with comprehensive medical management, the concept of total pancreatectomy and islet autotransplantation (TP-AIT) was introduced 40 years ago for patients with intractable pain and preserved beta-cell function. Read More

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http://dx.doi.org/10.1111/ajt.14880DOI Listing
August 2018
10 Reads

Posttransplant complications in adult recipients of intestine grafts without bowel decontamination.

J Surg Res 2018 05 21;225:125-130. Epub 2018 Feb 21.

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

Background: Selective digestive decontamination is commonly used to decrease lumenal bacterial flora. Preoperative bowel decontamination may be associated with a lower wound infection rate but has not been shown to decrease risk of intra-abdominal abscess or lower leak rate for enteric anastomoses. Alternatively, the decontamination disrupts the normal flora of the gastrointestinal tract and may affect normal physiology, including immunologic function. Read More

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http://dx.doi.org/10.1016/j.jss.2018.01.011DOI Listing
May 2018
5 Reads

Graft versus host disease after multivisceral transplantation: A UK center experience and update on management.

Clin Transplant 2018 05 16;32(5):e13239. Epub 2018 Apr 16.

Department of Transplant Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.

Graft versus host disease (GVHD) following transplantation of an intestine-containing graft occurs more frequently than with other solid organ transplants and is known to have a poor outcome. The presentation differs from other solid organ transplants, as the gastrointestinal tract is not involved following intestinal transplant. Diagnosis is based on clinical symptoms arising due to native tissue damage and the detection of donor T lymphocytes in circulating blood (T-cell chimerism). Read More

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http://dx.doi.org/10.1111/ctr.13239DOI Listing
May 2018
18 Reads

Invited Commentary on "Imaging of Intestinal and Multivisceral Transplantation".

Radiographics 2018 Mar-Apr;38(2):432-434

2 Department of Surgery and Transplantation, University of Alberta Hospital Edmonton, Alberta, Canada.

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http://pubs.rsna.org/doi/10.1148/rg.2018180002
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http://dx.doi.org/10.1148/rg.2018180002DOI Listing
April 2018
9 Reads

Imaging of Intestinal and Multivisceral Transplantation.

Radiographics 2018 Mar-Apr;38(2):413-432

From the Departments of Radiology (M.A.R., N.B.A., A.A.B., A.K.D.) and Surgery (R.J.C.), University of Pittsburgh Medical Center, 200 Lothrop St, Radiology Suite 200, East Wing E2051B, Pittsburgh, PA 15213; and Department of Surgery, Cleveland Clinic Foundation, Cleveland, Ohio (K.M.A., G.C.).

Intestinal transplantation has evolved from its experimental origins in the mid-20th century to its status today as an established treatment option for patients with end-stage intestinal failure who cannot be sustained with total parenteral nutrition. The most common source of intestinal failure in both adults and children is short-bowel syndrome, but a host of other disease processes can lead to this common end-point. The development of intestinal transplantation has presented multiple hurdles for the transplant community, including technical challenges, immunologic pitfalls, and infectious complications. Read More

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http://dx.doi.org/10.1148/rg.2018170086DOI Listing
August 2018
31 Reads

Myeloid-derived suppressor cells increase and inhibit donor-reactive T cell responses to graft intestinal epithelium in intestinal transplant patients.

Am J Transplant 2018 10 17;18(10):2544-2558. Epub 2018 Apr 17.

Transplant Center, Department of General Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.

Recent advances in immunosuppressive regimens have decreased acute cellular rejection (ACR) rates and improved intestinal and multivisceral transplant (ITx) recipient survival. We investigated the role of myeloid-derived suppressor cells (MDSCs) in ITx. We identified MDSCs as CD33 CD11b lineage(CD3/CD56/CD19) HLA-DR cells with 3 subsets, CD14 CD15 (e-MDSCs), CD14 CD15 (M-MDSCs), and CD14 CD15 (PMN-MDSCs), in peripheral blood mononuclear cells (PBMCs) and mononuclear cells in the grafted intestinal mucosa. Read More

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http://dx.doi.org/10.1111/ajt.14718DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6127002PMC
October 2018
14 Reads

Visceral transplantation in patients with intestinal-failure associated liver disease: Evolving indications, graft selection, and outcomes.

Am J Transplant 2018 06 6;18(6):1312-1320. Epub 2018 Apr 6.

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

Intestinal failure (IF)-associated liver disease (IFALD) is widely recognized as a lethal complication of long-term parenteral nutrition. The pathophysiology of IFALD is poorly understood but appears to be multifactorial and related to the inflammatory state in the patient with IF. Visceral transplant for IFALD includes variants of intestine, liver, or combined liver-intestine allografts. Read More

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http://dx.doi.org/10.1111/ajt.14715DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5992069PMC
June 2018
13 Reads

Complications in pediatric intestine transplantation in the absence of peri-operative donor or recipient bowel decontamination.

Pediatr Transplant 2018 05 2;22(3):e13164. Epub 2018 Mar 2.

Department of Surgery, Transplant Division, Indiana University School of Medicine, Indianapolis, IN, USA.

This study reports the clinical complication and infection rates of an active pediatric IT program that has never utilized bowel decontamination in either the donor or the recipient. All patients undergoing IT from 2003 to 2015 at a single pediatric IT center were reviewed. Post-transplant surgical, infectious, and immunosuppressive complications are reported. Read More

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http://dx.doi.org/10.1111/petr.13164DOI Listing
May 2018
15 Reads

Liver-inclusive intestinal transplantation results in decreased alloimmune-mediated rejection but increased infection.

Gastroenterol Rep (Oxf) 2018 Feb 28;6(1):29-37. Epub 2017 Dec 28.

Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

Background And Aims: A co-transplanted liver allograft has been thought to protect other organs from rejection-mediated injury; however, detailed analyses of co-transplanted liver on intestinal allograft outcomes have not been conducted to date. The aim of the study was to compare immune-mediated injury, causes of graft failure and clinical outcomes between recipients who underwent either a liver-inclusive intestinal transplant (LITx) or liver-exclusive intestinal transplant (LETx).

Methods: Between May 2000 and May 2010, 212 adult patients undergoing LITx (=76) and LETx (=136) were included. Read More

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http://dx.doi.org/10.1093/gastro/gox043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5806397PMC
February 2018
35 Reads

Modified Multivisceral Transplantation with Native Spleen Removal in Rats.

Eur J Pediatr Surg 2019 Jun 23;29(3):253-259. Epub 2018 Feb 23.

Cirugía Experimental, Fundacion Investigacion Biomedica Del Hospital Universitario La Paz, Madrid, Spain.

Background:  Modified multivisceral transplantation (MMVTx) refers to the use of a graft that includes all abdominal organs except the liver. The use of this type of transplant in children and adults expanded over the last years with good results. However, long-term survival in experimental models has not been reported. Read More

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http://dx.doi.org/10.1055/s-0038-1632375DOI Listing
June 2019
5 Reads

Multimodal Surgical Approach for Adult Patients With Chronic Intestinal Pseudo-Obstruction: Clinical and Psychosocial Long-term Outcomes.

Transplant Proc 2018 Jan - Feb;50(1):226-233

Department of Clinical Sciences, S. Anna-Cona University Hospital, Ferrara, Italy.

Background: Clinical and psychosocial outcomes of a multimodal surgical approach for chronic intestinal pseudo-obstruction were analyzed in 24 patients who were followed over a 2- to 12-year period in a single center after surgery or intestinal/multivisceral transplant (CTx).

Methods: The main reasons for surgery were sub-occlusion in surgery and parenteral nutrition-related irreversible complications with chronic intestinal failure in CTx.

Results: At the end of follow-up (February 2015), 45. Read More

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http://dx.doi.org/10.1016/j.transproceed.2017.11.012DOI Listing
July 2018
19 Reads