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  • Small Bowel Transplantation: DR Nilay Biswas Post Graduate Resident

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    Rajarshi Kumar
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    Small bowel transplantation involves transplanting an intestinal allograft to treat irreversible intestinal failure. Around 100 patients receive small bowel transplants each year, most often to treat conditions like necrotizing enterocolitis in children and Crohn's disease or mesenteric vascular thrombosis in adults. The transplant can involve the small bowel alone, the small bowel and liver, or a multivisceral transplant including other organs. Care after transplant requires monitoring for rejection and complications like bacterial translocation. Factors like life expectancy, ability to ingest food, and adherence to medical care determine whether a patient is eligible for this challenging procedure.

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    surgery

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    Seminar 15 March

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    Small bowel transplantation involves transplanting an intestinal allograft to treat irreversible intestinal failure. Around 100 patients receive small bowel transplants each year, most often to treat conditions like necrotizing enterocolitis in children and Crohn's disease or mesenteric vascular thrombosis in adults. The transplant can involve the small bowel alone, the small bowel and liver, or a multivisceral transplant including other organs. Care after transplant requires monitoring for rejection and complications like bacterial translocation. Factors like life expectancy, ability to ingest food, and adherence to medical care determine whether a patient is eligible for this challenging procedure.

    Copyright:

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    Download as PPT, PDF, TXT or read online from Scribd
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    8 views18 pages

    Small Bowel Transplantation: DR Nilay Biswas Post Graduate Resident

    Uploaded by

    Rajarshi Kumar
    Small bowel transplantation involves transplanting an intestinal allograft to treat irreversible intestinal failure. Around 100 patients receive small bowel transplants each year, most often to treat conditions like necrotizing enterocolitis in children and Crohn's disease or mesenteric vascular thrombosis in adults. The transplant can involve the small bowel alone, the small bowel and liver, or a multivisceral transplant including other organs. Care after transplant requires monitoring for rejection and complications like bacterial translocation. Factors like life expectancy, ability to ingest food, and adherence to medical care determine whether a patient is eligible for this challenging procedure.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
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    of 18

    Small Bowel

    Transplantation
    Dr Nilay Biswas

    Post Graduate Resident

    Background
    Small bowel transplantation was first attempted in humans in 1964. 100 patients receive small bowel transplants each year.
    Between 60 and 70 are kids age 18 and under.

    Small bowel transplant is the

    transplantation of an intestinal allograft to an individual with irreversible intestinal failure.


    The purpose of this transplant is to restore intestinal function.

    Indications
    Irreversible intestinal failure not successfully managed by TPN
    life-threatning complications while on TPN

    Intestinal failure
    In children 1. Necrotising enterocolitis
    2. Gastroschisis 3. Volvulus

    4. intestinal atresia

    Intestinal failure
    In adults
    1. Crohns disease

    2. Mesenteric vascular thrombosis


    3. Trauma

    4. Desmoid tumors

    Types of intestinal transplantation


    alone

    along with liver multivisceral (liver, pancreas, stomach, duodenum & colon )

    Types of donors

    deceased

    donors

    living donors

    Preoperative evaluation
    Medical

    Surgical

    Immunologic
    Psychosocial

    Surgical procedure
    Isolated intestinal transplant In living donor 200 cm of distal small bowel is used. Inflow to the graft is via ileocolic artery Outflow is via ileocolic vein In deceased donor graft is based on superior mesenteric artery for inflow and on the superior mesenteric vein for outflow

    Surgical procedure
    Combined liver and intestinal transplant

    Graft is procured intact with an aortic conduit containing both celiac and superior mesenteric arteries

    Surgical procedure
    Arterial inflow to the graft is achieved using the recipients infrarenal aorta by end-to-side anastomosis

    Venous drainage can be performed to the systemic or portal circulation


    GI continuity achieved

    Surgical procedure

    Postoperative care
    Initial care in ICU

    Monitoring of fluid, electrolyte and blood product replacement

    Broad spectrum antibiotics


    Monitoring of rejection by endoscopic biopsy of the graft mucosa

    Problems
    Immunologically small intestine is the most dificult organ to transplant

    Monitoring for rejection is difficult


    Bacterial translocation

    Contraindications
    Life expectancy of less than five years due to agerelated debilitation and co-morbidities Ability to ingest oral nutrition Unresectable malignancy Serious, uncontrolled psychiatric illness that would hinder compliance with any stage of the transplant process Neurologic illness independent of the disease process being treated
    Drug or alcohol addiction HIV (positive)

    Contraindications
    Active and / or life-threatening infection Severe body / organ system disease unrelated to transplanted organ Compromised cardio-pulmonary function unrelated to transplanted organ Inability or unwillingness of the individual or legal guardian to give signed consent and to comply with regular follow-up requirements

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