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Intestinal Transplant Techniques: From Isolated Intestine to Intestine in Continuity with Other Organs

  • Jason S. Hawksworth
  • Cal S. Matsumoto
Reference work entry
Part of the Organ and Tissue Transplantation book series (OTT)

Abstract

Intestine transplantation has revolutionized the management of the pediatric patient with intestine failure and total parenteral nutrition-related complications. Pediatric intestinal transplantation is a technically demanding procedure, requiring intimate knowledge of advanced techniques in both pediatric liver transplantation and gastrointestinal surgery. Individualization of the procedure is required based on recipient gastrointestinal anatomy, function, and vascular complications of parenteral nutrition in the child. The term “intestinal transplant” comprises not only isolated intestinal transplant but also combined liver–intestinal and multivisceral transplants. When only the jejunum and ileum are transplanted, this is conventionally known as an isolated intestinal transplant. In the setting of advanced liver disease, combined liver and intestine are generally transplanted en bloc with the pancreas. The native foregut is preserved in children whenever possible, and venous drainage with a portacaval shunt is required. This variation is referred to as a liver–intestine transplant. Multivisceral transplantation incorporates the stomach and entire duodenum with the liver and intestine graft. The modified multivisceral variant excludes the liver and is rarely employed in children. Paramount to the success of intestine transplantation has been the refinement of recipient transplantation techniques. Appropriate technical and logistical planning will minimize technical failures, which have long-term implications in the pediatric recipient.

Keywords

Abdominal closure Acute rejection Enterectomy Gastrectomy Intestine failure Intestine transplant Multiorgan transplant Multivisceral transplant Parenteral nutrition Portacaval shunt Sensitization Short gut syndrome Vascular conduit 

Notes

Acknowledgments

We kindly thank David Klemm for his artistic expertise in creating figures 1, 4, 7, 10.

References

  1. Abu-Elmagd KM, Wu G, Costa G, Lunz J, Martin L, Koritsky DA, Murase N, Irish W, Zeevi A (2012) Preformed and de novo donor specific antibodies in visceral transplantation: long-term outcome with special reference to the liver. Am J Transplant 12(11):3047–3060CrossRefPubMedGoogle Scholar
  2. Berney T, Kato T, Nishida S, Tector AJ, Mittal NK, Madariaga J, Nery JR, Cantwell GP, Ruiz P, Tzakis AG (2002) Portal versus systemic drainage of small bowel allografts: comparative assessment of survival, function, rejection, and bacterial translocation. J Am Coll Surg 195(6):804–813CrossRefPubMedGoogle Scholar
  3. Fishbein TM (2004) The current state of intestinal transplantation. Transplantation 78(2):175–178CrossRefPubMedGoogle Scholar
  4. Fishbein TM (2009) Intestinal transplantation. N Engl J Med 361(10):998–1008CrossRefPubMedGoogle Scholar
  5. Fishbein T, Schiano T, Jaffe D, Kim-Schluger L, Facciuto M, Emre S, Sheiner P, Schwartz M, O'Rourke M, Miller C (2000) Isolated intestinal transplantation in adults with nonreconstructible GI tracts. Transplant Proc 32(6):1231–1232CrossRefPubMedGoogle Scholar
  6. Fishbein TM, Kaufman SS, Florman SS, Gondolesi GE, Schiano T, Kim-Schluger L, Magid M, Harpaz N, Tschernia A, Leibowitz A, LeLeiko NS (2003a) Isolated intestinal transplantation: proof of clinical efficacy. Transplantation 76(4):636–640CrossRefPubMedGoogle Scholar
  7. Fishbein T, Florman S, Gondolesi G, Decker R (2003b) Noncomposite simultaneous liver and intestinal transplantation. Transplantation 75(4):564–565CrossRefPubMedGoogle Scholar
  8. Fishbein TM, Gondolesi GE, Kaufman SS (2003c) Intestinal transplantation for gut failure. Gastroenterology 124(6):1615–1628CrossRefPubMedGoogle Scholar
  9. Kato T, Selvaggi G, Gaynor JJ, Takahashi H, Nishida S, Moon J, Levi D, Smith L, Hernandez E, Ruiz P, Tzakis A (2008) Inclusion of donor colon and ileocecal valve in intestinal transplantation. Transplantation 86(2):293–297CrossRefPubMedGoogle Scholar
  10. Matsumoto C, Kaufman S, Fennelly E, Davis J, Gupta P, Fishbein TM (2006) Impact of positive preoperative surveillance blood cultures from chronic indwelling catheters in cadaveric intestinal transplant recipients. Transplant Proc 38(6):1676–1677CrossRefPubMedGoogle Scholar
  11. Matsumoto CS, Kaufman SS, Fishbein TM (2011) Inclusion of the colon in intestinal transplantation. Curr Opin Organ Transplant 16(3):312–315CrossRefPubMedGoogle Scholar
  12. Mazariegos GV, Squires RH, Sindhi RK (2009) Current perspectives on pediatric intestinal transplantation. Curr Gastroenterol Rep 11(3):226–233CrossRefPubMedGoogle Scholar
  13. Mims TT, Fishbein TM, Feierman DE (2004) Management of a small bowel transplant with complicated central venous access in a patient with asymptomatic superior and inferior vena cava obstruction. Transplant Proc 36(2):388–391CrossRefPubMedGoogle Scholar
  14. Reyes J, Bueno J, Kocoshis S, Green M, Abu-Elmagd K, Furukawa H, Barksdale EM, Strom S, Fung JJ, Todo S, Irish W, Starzl TE (1998) Current status of intestinal transplantation in children. J Pediatr Surg 33(2):243–254CrossRefPubMedPubMedCentralGoogle Scholar
  15. Reyes J, Mazariegos GV, Bond GM, Green M, Dvorchik I, Kosmach-Park B, Abu-Elmagd K (2002) Pediatric intestinal transplantation: historical notes, principles and controversies. Pediatr Transplant 6(3):193–207CrossRefPubMedGoogle Scholar
  16. Sudan DL, Iyer KR, Deroover A, Chinnakotla S, Fox IJ Jr, Shaw BW Jr, Langnas AN (2001) A new technique for combined liver/small intestinal transplantation. Transplantation 72(11):1846–1848CrossRefPubMedGoogle Scholar
  17. Tzakis AG, Todo S, Reyes J, Nour B, Fung JJ, Starzl TE (1993) Piggyback orthotopic intestinal transplantation. Surg Gynecol Obstet 176(3):297–298PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Georgetown University Hospital, Transplant InstituteWashingtonUSA

Section editors and affiliations

  • George Mazariegos
    • 1
  • Donna Basille
    • 2
  1. 1.Children's Hospital of PittsburghPittsburghUSA
  2. 2.University of Pittsburgh Medical CenterPittsburghUSA

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