Skip to main content

Advertisement

Log in

Small bowel transplant: state-of-the-art vascular and nonvascular imaging

  • Review
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Background

Small bowel transplant (SBT) is a surgical procedure that may be used in patients with pathology resulting in severe intestinal failure resistant to conventional forms of surgical and nonsurgical treatment. Intestinal failure is defined as the failure of enterocytes to absorb sufficient macronutrients, water, and/or electrolytes to sustain homeostasis and/or promote growth. With the advancement of surgical techniques and advancements in perioperative transplant management, SBT has become an increasingly common treatment for intestinal failure, with survival rates for SBT comparable to those for other solid organ transplants.

Materials and methods

This review provides background on SBT, its variations, and the associated preoperative and postoperative imaging studies with regard to surgical planning and anticipated complications.

Results and conclusions

With the increasing use of SBT, radiologists will be expected to be familiar with the diagnostic studies and available endovascular interventions associated with this procedure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13

Similar content being viewed by others

References

  1. Pironi L, Arends J, Bozzetti F, et al. ESPEN guidelines on chronic intestinal failure in adults. Clin Nutr. 2016;35(2):247-307. https://doi.org/10.1016/j.clnu.2016.01.020

    Article  PubMed  Google Scholar 

  2. Pironi L, Arends J, Baxter J, et al. ESPEN endorsed recommendations. Definition and classification of intestinal failure in adults. Clin Nutr. 2015;34(2):171-180. https://doi.org/10.1016/j.clnu.2014.08.017

    Article  Google Scholar 

  3. Bharadwaj S, Tandon P, Gohel TD, et al. Current status of intestinal and multivisceral transplantation. Gastroenterol Rep. 2017;5(1):20-28. https://doi.org/10.1093/gastro/gow045

    Article  Google Scholar 

  4. Grant D, Abu-Elmagd K, Reyes J, et al. 2003 report of the intestine transplant registry: a new era has dawned. Ann Surg. 2005;241(4):607-613. https://doi.org/10.1097/01.sla.0000157265.85388.a1

    Article  PubMed  PubMed Central  Google Scholar 

  5. American Gastroenterological Association medical position statement: short bowel syndrome and intestinal transplantation. Gastroenterology. 2003;124(4):1105-1110. https://doi.org/10.1053/gast.2003.50139

  6. Rees MA, Amesur NB, Cruz RJ, et al. Imaging of Intestinal and Multivisceral Transplantation. Radiographics. 2018;38(2):413-432. https://doi.org/10.1148/rg.2018170086

    Article  PubMed  Google Scholar 

  7. Costa G, Parekh N, Osman M, Armanyous S, Fujiki M, Abu-Elmagd K. Composite and Multivisceral Transplantation: Nomenclature, Surgical Techniques, Current Practice, and Long-term Outcome. Surg Clin North Am. 2019;99(1):129-151. https://doi.org/10.1016/j.suc.2018.09.010

    Article  PubMed  Google Scholar 

  8. Abu-Elmagd KM, Costa G, McMichael D, et al. Autologous Reconstruction and Visceral Transplantation for Management of Patients With Gut Failure After Bariatric Surgery: 20 Years of Experience. Ann Surg. 2015;262(4):586-601. https://doi.org/10.1097/sla.0000000000001440

    Article  PubMed  Google Scholar 

  9. Huijbers A, Koggel LM, Bronkhorst C, Verheij J, Wanten GJA. Systematic Review: Noninvasive Assessments of Intestinal Failure-Associated Liver Disease in the Adult Population. JPEN J Parenter Enteral Nutr. April 2019. https://doi.org/10.1002/jpen.1524

    Article  PubMed  Google Scholar 

  10. Pironi L, Sasdelli AS. Intestinal Failure-Associated Liver Disease. Clin Liver Dis. 2019;23(2):279-291. https://doi.org/10.1016/j.cld.2018.12.009

    Article  PubMed  Google Scholar 

  11. Buchman AL, Iyer K, Fryer J. Parenteral nutrition-associated liver disease and the role for isolated intestine and intestine/liver transplantation. Hepatology. 2006;43(1):9-19. https://doi.org/10.1002/hep.20997

    Article  PubMed  Google Scholar 

  12. Grant D, Abu-Elmagd K, Mazariegos G, et al. Intestinal transplant registry report: global activity and trends. Am J Transplant. 2015;15(1):210-219. https://doi.org/10.1111/ajt.12979

    Article  CAS  PubMed  Google Scholar 

  13. Abu-Elmagd KM, Kosmach-Park B, Costa G, et al. Long-term survival, nutritional autonomy, and quality of life after intestinal and multivisceral transplantation. Ann Surg. 2012;256(3):494-508. https://doi.org/10.1097/sla.0b013e318265f310

    Article  PubMed  Google Scholar 

  14. Abu-Elmagd KM, Costa G, Bond GJ, et al. Five hundred intestinal and multivisceral transplantations at a single center: major advances with new challenges. Ann Surg. 2009;250(4):567-581. https://doi.org/10.1097/sla.0b013e3181b67725

    Article  PubMed  Google Scholar 

  15. Pittiruti M, Hamilton H, Biffi R, MacFie J, Pertkiewicz M. ESPEN Guidelines on Parenteral Nutrition: central venous catheters (access, care, diagnosis and therapy of complications). Clin Nutr. 2009;28(4):365-377. https://doi.org/10.1016/j.clnu.2009.03.015

    Article  PubMed  Google Scholar 

  16. Buchman AL, Scolapio J, Fryer J. AGA technical review on short bowel syndrome and intestinal transplantation. Gastroenterology. 2003;124(4):1111-1134. https://doi.org/10.1016/s0016-5085(03)70064-x

    Article  PubMed  Google Scholar 

  17. Smith JM, Weaver T, Skeans MA, et al. OPTN/SRTR 2017 Annual Data Report: Intestine. Am J Transplant. 2019;19 Suppl 2:284-322. https://doi.org/10.1111/ajt.15277

    Article  PubMed  Google Scholar 

  18. Swerdlow DR, Trotter A, Girlanda R, Matsumoto C, Fenelly E. Computed tomography (CT) colonography with CT arteriography and venography for the workup of intestinal transplant candidates. Clin Transplant. 2013;27(1):126-131. https://doi.org/10.1111/ctr.12025

    Article  CAS  PubMed  Google Scholar 

  19. Nickkholgh A, Contin P, Abu-Elmagd K, et al. Intestinal transplantation: review of operative techniques. Clin Transplant. 2013;27 Suppl 2:56-65. https://doi.org/10.1111/ctr.12190

    Article  PubMed  Google Scholar 

  20. Godfrey EM, Upponi SS, See TC, et al. A radiologist’s guide to small bowel and multivisceral transplantation. Clin Radiol. 2013;68(10):983-991. https://doi.org/10.1016/j.crad.2013.03.010

    Article  CAS  PubMed  Google Scholar 

  21. Partovi S, Loebe M, Noon GP, et al. Detection of adventitial vasa vasorum and intraplaque neovascularization in carotid atherosclerotic lesions with contrast-enhanced ultrasound and their role in atherosclerosis. Methodist Debakey Cardiovasc J. 2011;7(4):37-40.

    Article  Google Scholar 

  22. Partovi S, Loebe M, Aschwanden M, et al. Contrast-enhanced ultrasound for assessing carotid atherosclerotic plaque lesions. AJR Am J Roentgenol. 2012;198(1):W13-9. https://doi.org/10.2214/ajr.11.7312

    Article  PubMed  Google Scholar 

  23. Staub D, Partovi S, Imfeld S, et al. (2013) Novel applications of contrast-enhanced ultrasound imaging in vascular medicine. Vasa. 42(1):17–31. https://doi.org/10.1024/0301-1526/a000244

    Article  PubMed  Google Scholar 

  24. ACR AC of R. ACR Manual on Contrast Media Version 10.3. https://www.acr.org/Quality-Safety/Resources/Contrast-Manual. Published 2017. Accessed August 22, 2019.

  25. Tzakis AG, Kato T, Levi DM, et al. 100 multivisceral transplants at a single center. Ann Surg. 2005;242(4):480-483. https://doi.org/10.1097/01.sla.0000183347.61361.7a

    Article  PubMed  PubMed Central  Google Scholar 

  26. Gerlach UA, Pascher A. Technical advances for abdominal wall closure after intestinal and multivisceral transplantation. Curr Opin Organ Transplant. 2012;17(3):258-267. https://doi.org/10.1097/mot.0b013e3283534d7b

    Article  PubMed  Google Scholar 

  27. Sheth J, Sharif K, Lloyd C, et al. Staged abdominal closure after small bowel or multivisceral transplantation. Pediatr Transplant. 2012;16(1):36-40. https://doi.org/10.1111/j.1399-3046.2011.01597.x

    Article  CAS  PubMed  Google Scholar 

  28. Cruz RJJ, Costa G, Bond G, et al. Modified “liver-sparing” multivisceral transplant with preserved native spleen, pancreas, and duodenum: technique and long-term outcome. J Gastrointest Surg. 2010;14(11):1709-1721. https://doi.org/10.1007/s11605-010-1317-5

    Article  PubMed  Google Scholar 

  29. Bueno J, Abu-Elmagd K, Mazariegos G, Madariaga J, Fung J, Reyes J. Composite liver--small bowel allografts with preservation of donor duodenum and hepatic biliary system in children. J Pediatr Surg. 2000;35(2):291-296.

    Article  CAS  Google Scholar 

  30. Grant D, Wall W, Mimeault R, et al. Successful small-bowel/liver transplantation. Lancet (London, England). 1990;335(8683):181-184.

    Article  CAS  Google Scholar 

  31. Papachristou GI, Abu-Elmagd KM, Bond G, et al. Pancreaticobiliary complications after composite visceral transplantation: incidence, risk, and management strategies. Gastrointest Endosc. 2011;73(6):1165-1173. https://doi.org/10.1016/j.gie.2011.01.024

    Article  PubMed  Google Scholar 

  32. Borhani AA, Dasyam AK, Papachristou G, et al. Radiologic features of pancreatic and biliary complications following composite visceral transplantation. Abdom Imaging. 2015;40(6):1961-1970. https://doi.org/10.1007/s00261-014-0338-z

    Article  PubMed  Google Scholar 

  33. Abu-Elmagd KM. Preservation of the native spleen, duodenum, and pancreas in patients with multivisceral transplantation: nomenclature, dispute of origin, and proof of premise. Transplantation. 2007;84(9):1208-1209; author reply 1209. https://doi.org/10.1097/01.tp.0000287242.61220.4a

    Article  Google Scholar 

  34. Kato T, Tzakis AG, Selvaggi G, et al. Transplantation of the spleen: effect of splenic allograft in human multivisceral transplantation. Ann Surg. 2007;246(3):436. https://doi.org/10.1097/sla.0b013e3181485124

    Article  PubMed  PubMed Central  Google Scholar 

  35. Abu-Elmagd K, Reyes J, Bond G, et al. Clinical intestinal transplantation: a decade of experience at a single center. Ann Surg. 2001;234(3):404-407. https://doi.org/10.1097/00000658-200109000-00014

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Sandrasegaran K, Lall C, Ramaswamy R, et al. Intestinal and multivisceral transplantation. Abdom Imaging. 2011;36(4):382-389. https://doi.org/10.1007/s00261-010-9680-y

    Article  PubMed  Google Scholar 

  37. Duszak RLJ, Levy JM, Akins EW, et al. Percutaneous catheter drainage of infected intra-abdominal fluid collections. American College of Radiology. ACR Appropriateness Criteria. Radiology. 2000;215 Suppl:1067-1075.

  38. Kinner S, Umutlu L, Dechene A, et al. Biliary complications after liver transplantation: addition of T1-weighted images to MR cholangiopancreatography facilitates detection of cast in biliary cast syndrome. Radiology. 2012;263(2):429-436. https://doi.org/10.1148/radiol.12111625

    Article  PubMed  Google Scholar 

  39. Kinner S, Dechene A, Ladd SC, et al. Comparison of different MRCP techniques for the depiction of biliary complications after liver transplantation. Eur Radiol. 2010;20(7):1749-1756. https://doi.org/10.1007/s00330-010-1714-x

    Article  PubMed  Google Scholar 

  40. Norton PT, DeAngelis GA, Ogur T, Saad WE, Hagspiel KD. Noninvasive vascular imaging in abdominal solid organ transplantation. AJR Am J Roentgenol. 2013;201(4):W544-53. https://doi.org/10.2214/ajr.13.11306

    Article  PubMed  Google Scholar 

  41. Unsinn KM, Koenigsrainer A, Rieger M, et al. Spectrum of imaging findings after intestinal, liver-intestinal, or multivisceral transplantation: part 2, posttransplantation complications. AJR Am J Roentgenol. 2004;183(5):1285-1291. https://doi.org/10.2214/ajr.183.5.1831285

    Article  PubMed  Google Scholar 

  42. Ruiz P. Updates on acute and chronic rejection in small bowel and multivisceral allografts. Curr Opin Organ Transplant. 2014;19(3):293-302. https://doi.org/10.1097/mot.0000000000000075

    Article  PubMed  Google Scholar 

  43. Fishbein TM. Intestinal transplantation. N Engl J Med. 2009;361(10):998-1008. https://doi.org/10.1056/nejmra0804605

    Article  CAS  PubMed  Google Scholar 

  44. Sigurdsson L, Reyes J, Kocoshis SA, Mazariegos G, Abu-Elmagd K, Green M. Bacteremia after intestinal transplantation in children correlates temporally with rejection or gastrointestinal lymphoproliferative disease. Transplantation. 2000;70(2):302-305.

    Article  CAS  Google Scholar 

  45. Guaraldi G, Cocchi S, De Ruvo N, et al. Outcome, incidence, and timing of infections in small bowel/multivisceral transplantation. Transplant Proc. 2004;36(2):383-385. https://doi.org/10.1016/j.transproceed.2003.12.004

    Article  CAS  PubMed  Google Scholar 

  46. Loinaz C, Kato T, Nishida S, et al. Bacterial infections after intestine and multivisceral transplantation. Transplant Proc. 2003;35(5):1929-1930

    Article  CAS  Google Scholar 

  47. Amesur NB, Zajko AB, Costa G, Abu-Elmagd KM. Combined surgical and interventional radiologic management strategies in patients with arterial pseudo-aneurysms after multivisceral transplantation. Transplantation. 2014;97(2):235-244. https://doi.org/10.1097/tp.0b013e3182a9029a

    Article  PubMed  Google Scholar 

  48. Pascher A, Neuhaus P. Biliary complications after deceased-donor orthotopic liver transplantation. J Hepatobiliary Pancreat Surg. 2006;13(6):487-496. https://doi.org/10.1007/s00534-005-1083-z

    Article  PubMed  Google Scholar 

  49. Aufort S, Molina E, Assenat E, et al. [Value of MRCP for diagnosis of biliary complications after liver transplantation]. J Radiol. 2008;89(2):221-227.

    Article  CAS  Google Scholar 

  50. Ganoza A, Mazariegos G V, Khanna A. Current status of graft-versus-host disease after intestinal transplantation. Curr Opin Organ Transplant. 2019;24(2):199-206. https://doi.org/10.1097/mot.0000000000000624

    Article  PubMed  Google Scholar 

  51. Ratanatharathorn V, Nash RA, Przepiorka D, et al. Phase III study comparing methotrexate and tacrolimus (prograf, FK506) with methotrexate and cyclosporine for graft-versus-host disease prophylaxis after HLA-identical sibling bone marrow transplantation. Blood. 1998;92(7):2303-2314.

    CAS  PubMed  Google Scholar 

  52. Kalantari BN, Mortele KJ, Cantisani V, et al. CT features with pathologic correlation of acute gastrointestinal graft-versus-host disease after bone marrow transplantation in adults. AJR Am J Roentgenol. 2003;181(6):1621-1625. https://doi.org/10.2214/ajr.181.6.1811621

    Article  PubMed  Google Scholar 

  53. Borhani AA, Hosseinzadeh K, Almusa O, Furlan A, Nalesnik M. Imaging of posttransplantation lymphoproliferative disorder after solid organ transplantation. Radiographics. 2009;29(4):981-982. https://doi.org/10.1148/rg.294095020

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to express their gratitude to Megan Griffiths for her thoughtful review of the manuscript and the Cleveland Clinic Interventional Radiology Department for their impactful work.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Catherine E. P. Panick.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

CME activity This article has been selected as the CME activity for the current month. Please visit https://ce.mayo.edu/node/95230 and follow the instructions to complete this CME activity.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Panick, C.E.P., Partovi, S., Liu, P.S. et al. Small bowel transplant: state-of-the-art vascular and nonvascular imaging. Abdom Radiol 45, 601–614 (2020). https://doi.org/10.1007/s00261-019-02377-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-019-02377-6

Keywords

Navigation