Choice of Allograft in Patients Requiring Intestinal Transplantation: A Critical Review
Autor: | Kishore Iyer, Thomas D. Schiano, Genevieve Huard, Jang Moon |
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Rok vydání: | 2017 |
Předmět: |
medicine.medical_specialty
Cirrhosis Waiting Lists Review Article 030230 surgery Severity of Illness Index Gastroenterology 03 medical and health sciences 0302 clinical medicine Internal medicine medicine.artery Severity of illness medicine Humans Superior mesenteric artery lcsh:RC799-869 Hepatology business.industry Patient Selection Gastrointestinal pathology General Medicine Allografts medicine.disease Combined Modality Therapy Thrombosis Liver Transplantation Surgery Intestines Transplantation Intestinal Diseases Parenteral nutrition lcsh:Diseases of the digestive system. Gastroenterology 030211 gastroenterology & hepatology Liver function business Liver Failure |
Zdroj: | Canadian Journal of Gastroenterology and Hepatology, Vol 2017 (2017) Canadian Journal of Gastroenterology & Hepatology |
ISSN: | 2291-2797 2291-2789 |
Popis: | Intestinal transplantation (ITx) is indicated in patients with irreversible intestinal failure (IF) and life-threatening complications related to total parenteral nutrition (TPN). ITx can be classified into three main types. Isolated intestinal transplantation (IITx), that is, transplantation of the jejunoileum, is indicated in patients with preserved liver function. Combined liver-intestine transplantation (L-ITx), that is, transplantation of the liver and the jejunoileum, is indicated in patients with liver failure related to TPN. Thus, patients with cirrhosis or advanced fibrosis should receive a combined allograft, while patients with lower grades of liver fibrosis can usually safely undergo ITx. Reflecting their degree of sickness, the waitlist mortality rate and the early posttransplant outcomes of patients receiving L-ITx are worse than IITx. However, L-ITx is associated with better long-term graft and patient survival. Multivisceral transplantation (MVTx), that is, transplantation of the organs dependent on the celiac axis and superior mesenteric artery, can be classified into full MVTx if it includes the liver and modified MVTx if it does not. The most common indications for MVTx are extensive portomesenteric thrombosis and diffuse gastrointestinal pathology such as motility disorders and polyposis syndrome. Every patient with IF should undergo a multidisciplinary evaluation by an experienced ITx team. |
Databáze: | OpenAIRE |
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