Intestinal Transplantation

In Safe Hands

• Home
• Int. Transplantation in the UK
• Indications in Adults
• UK Transplant & Failure Centres
• How to Refer a Patient
• Information for Patients
• Publications
• Links

NASIT Forum meeting

Dates & locations

Monday 13 May 2013. 2pm

Addenbroke's Hospital

Cambridge University Hospital
NHS Trust,
Cambridge

26 - 29 June 2013

Oxford Town Hall

St. Aldate's

United Kingdom
http://www.isbts2013.org

Wednesday 10 July 2013. 2pm

John Radcliffe Hospital

Oxford

Monday 9 Sept 2013. 2pm

The Hope

Salford Royal Hospital
NHS Trust, Manchester.

Friday 22 Nov 2013. 2pm

St. Mark's Hospital,
Seminar room 5, Level 6
Unit
Watford Road Harrow
...

Monday 6 Jan 2014. 2pm

Addenbroke's Hospital

Cambridge University Hospital
NHS Trust,
Cambridge

Wednesday 5 Mar 2014

John Radcliffe Hospital

Oxford

 

 

Call:

Is intestinal transplantation now an alternative to home parenteral nutrition?
Middleton SJ.
Proc Nutr Soc. 2007 Aug;66(3):316-20

Patients with irreversible intestinal failure and complications of parenteral nutrition should now be routinely considered for small intestine transplantation. Despite attempts for >40 years immunological graft intolerance presented an impenetrable barrier to successful engraftment until the development in the late 1970s of the powerful calcineurin-inhibitor immunosuppressive agents. Their use over the last 17 years has led to small intestinal transplantation being generally considered as a routine option for patients with irreversible intestinal failure and failing parenteral nutrition. The 1-year patient survival rates (%) are now excellent for renal (95), liver (78), heart (82) and lung (75) transplantation. In contrast, survival rates for small intestinal transplantation have been slow to improve, although they are now approaching those for lung and liver transplantation (intestine 78%, intestine and liver 60%, multivisceral 66%), and well-performing centres report recent 1-year graft survival rates as high as 92%. Patient 5-year survival (%) has also improved (intestine alone 50, intestine and liver 50 and multivisceral 62) and compares increasingly favourably with renal (85), liver (67), heart (67) and lung (46). Currently, small intestinal transplantation is reserved for patients with irreversible small intestinal failure who have a poor prognosis on parenteral nutrition. However, as 5-year patient survival following intestinal transplantation approaches that for parenteral nutrition there will be increasing pressure to offer this modality of treatment as an alternative to parenteral nutrition, especially for those patients who have a poor quality of life as a result of parenteral nutrition.

Small bowel transplantation in the UK.
Middleton SJ, Jamieson NV
Gut. 2006 Jul;55(7):1047

 

The current status of small bowel transplantation in the UK and internationally.
Middleton SJ, Jamieson NV
Gut. 2005 Nov;54(11):1650-7

 

Adult small intestinal transplantation in England and Wales.
Middleton SJ, Pollard S, Friend PJ, Watson C, Calne RY, Davies M, Cameron EA,
Gimson AE, Bradley JA, Shaffer J, Jamieson NV.
Br J Surg. 2003 Jun;90(6):723-7

In 1996 two transplantation centres in the UK were commissioned by the National Specialist Commissioning Advisory Group for England and Wales to assess small intestinal transplantation in adults. The joint experience of the two centres is presented. METHODS: Patients with irreversible small intestinal failure and complications of parenteral nutrition, and those with abdominal disease requiring extensive visceral resection, were assessed as candidates and where appropriate listed for surgery. RESULTS: Thirty-six patients were assessed for small intestinal transplantation and, of these, 14 underwent surgery. Twelve patients survived the transplantation procedure. Of these, seven patients were alive at 1 year, five at 3 years and three at 5 years. Three patients remain alive. Patient and graft survival improved with experience; the 1-year survival rate improved in the last 4 years of this experience from 43 to 57 per cent, and the 3-year survival rate from 29 to 43 per cent.

CONCLUSION: Small intestinal transplantation is associated with a high mortality rate but may benefit carefully selected patients in whom conservative management is likely to carry a greater mortality rate.

 

Quality of life in adults following small bowel transplantation.
Cameron EA, Binnie JA, Jamieson NV, Pollard S, Middleton SJ.
Transplant Proc. 2002 May;34(3):965-6

 

Retrieval of abdominal organs for transplantation.
Brockmann JG, Vaidya A, Reddy S, Friend PJ.
Br J Surg. 2006 Feb;93(2):133-46

Organ retrieval and donor management are not yet standardized. Different transplant centres apply various techniques, such as single or dual organ perfusion, dissection in the cold or warm, and single or en bloc organ removal. These different approaches may cause inconvenience, especially when more than one organ retrieval team is involved. METHODS: Cochrane Library, Medline and PubMed were searched for publications on multiorgan donor/donation, retrieval technique and procurement. Levels of evidence and grades of recommendation were evaluated based on current advice from the Oxford Centre for Evidence-Based Medicine. RESULTS: Multiorgan donation itself does not compromise the outcome of individual organ transplants. Dissection of abdominal organs for transplantation is best performed after cold perfusion. Abdominal organs should be removed rapidly, en bloc, and separated during back-table dissection in the cold, particularly if pancreas or intestine is included. Perfusion itself should be carried out after single cannulation of the aorta with an increased pressure.
CONCLUSION: Although the literature on organ retrieval is extensive, the level of evidence provided is mainly low. Nevertheless, optimized donor treatment and organ retrieval should increase the number and quality of cadaveric donor organs and improve graft function and survival.