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Chapter 36 - Intestinal transplantation

from Section 6 - Other abdominal organs

Published online by Cambridge University Press:  07 September 2011

By
Stephen J. Middleton ,
Simon M. Gabe ,
Neville V. Jamieson  and
Andrew J. Butler
Edited by
Andrew A. Klein ,
Clive J. Lewis  and
Joren C. Madsen
Andrew A. Klein
Affiliation:
Papworth Hospital NHS Trust
Clive J. Lewis
Affiliation:
Papworth Hospital NHS Trust
Joren C. Madsen
Affiliation:
Massachusetts General Hospital
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Summary

Parenteral nutrition (PN) remains the primary treatment for patients with irreversible intestinal failure. The risks associated with the transplantation procedure are increased when venous access falls below two or three major veins, depending on the extent of the planned surgery. Patients find their quality of life considerably impaired by PN and explore the possibility of intestinal transplantation as a way of improving it. Tacrolimus (TAC) should be started on the second postoperative day. Between 50% and 75% of patients experience rejection in the first few postoperative months. The presence of donor-specific antibodies increases the risk of acute rejection, and panel-reactive antibodies (PRA) correlates with the incidence of acute rejection of the intestinal graft. It is essential to have a well organized follow-up schedule that allows detection of problems at an early stage. Psychological issues tend to come to the forefront as the physical problems occur less frequently.

Keywords

cardiovascular diseasechronic rejectionde novo malignancyimmune suppressionliver transplantationhypertensiondiabetesmetabolic syndromesurgical complications
Type
Chapter
Information
Organ Transplantation
A Clinical Guide
 , pp. 303 - 312
Publisher: Cambridge University Press
Print publication year: 2011

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