Cadaveric Small Bowel and Small Bowel-liver Transplantation in Humans

Overview

Journal Transplantation

Specialty General Surgery

Date 1992 Feb 1

PMID 1738932

Citations 38

Authors

S Todo

A G Tzakis

K Abu-Elmagd

J Reyes

J J Fung

A Casavilla

K Nakamura

A Yagihashi

A Jain

N Murase

Affiliations

Soon will be listed here.

Abstract

Five patients had complete cadaveric small bowel transplants under FK506 immunosuppression, one as an isolated graft and the other 4 in continuity with a liver. Three were children and two were adults. The five patients are living 2-13 months posttransplantation with complete alimentation by the intestine. The typical postoperative course was stormy, with sluggish resumption of gastrointestinal function. The patient with small intestinal transplantation alone had the most difficult course of the five, including two severe rejections, bacterial and fungal translocation with bacteremia, renal failure with the rejections, and permanent consignment to renal dialysis. The first four patients (studies on the fifth were incomplete) had replacement of the lymphoreticular cells in the graft lamina propria by their own lymphoreticular cells. Although the surgical and after-care of these patients was difficult, the eventual uniform success suggests that intestinal transplantation has moved toward becoming a practical clinical service.

Citing Articles

The concept of gut rehabilitation and the future of visceral transplantation.

Abu-Elmagd K Nat Rev Gastroenterol Hepatol. 2015; 12(2):108-20.

PMID: 25601664 DOI: 10.1038/nrgastro.2014.216.

India's first successful intestinal transplant: the road traveled and the lessons learnt.

Soin A, Mohanka R, Saraf N, Rastogi A, Goja S, Menon B Indian J Gastroenterol. 2014; 33(2):104-13.

PMID: 24500752 DOI: 10.1007/s12664-013-0437-8.

Themes of liver transplantation.

Starzl T, Fung J Hepatology. 2010; 51(6):1869-84.

PMID: 20235333 PMC: 4507423. DOI: 10.1002/hep.23595.

Auxiliary en-bloc liver-small bowel transplantation with partial pancreas preservation in pigs.

Yin Z, Ni X, Jiang F, Li N, Li Y, Wang X World J Gastroenterol. 2004; 10(10):1499-503.

PMID: 15133861 PMC: 4656292. DOI: 10.3748/wjg.v10.i10.1499.

Modifications in combined liver-small bowel transplantation in pigs.

Jiang F, Yin Z, Ni X, Li Y, Li N, Li J World J Gastroenterol. 2003; 9(9):2125-7.

PMID: 12970921 PMC: 4656689. DOI: 10.3748/wjg.v9.i9.2125.

References

Murase N, Kim D, Todo S, Cramer D, Fung J, Starzl T . Induction of liver, heart, and multivisceral graft acceptance with a short course of FK 506. Transplant Proc. 1990; 22(1):74-5. PMC: 2903852. View

Lillehei R, GOOTT B, Miller F . The physiological response of the small bowel of the dog to ischemia including prolonged in vitro preservation of the bowel with successful replacement and survival. Ann Surg. 1959; 150:543-60. PMC: 1613469. DOI: 10.1097/00000658-195910000-00001. View

Hoffman A, Makowka L, Banner B, Cai X, Cramer D, Pascualone A . The use of FK-506 for small intestine allotransplantation. Inhibition of acute rejection and prevention of fatal graft-versus-host disease. Transplantation. 1990; 49(3):483-90. PMC: 2987596. DOI: 10.1097/00007890-199003000-00001. View

Todo S, Fung J, Starzl T, Tzakis A, Demetris A, Kormos R . Liver, kidney, and thoracic organ transplantation under FK 506. Ann Surg. 1990; 212(3):295-305; discussion 306-7. PMC: 1358160. DOI: 10.1097/00000658-199009000-00008. View

Iwaki Y, Starzl T, Yagihashi A, Taniwaki S, Abu-Elmagd K, Tzakis A . Replacement of donor lymphoid tissue in small-bowel transplants. Lancet. 1991; 337(8745):818-9. PMC: 2983478. DOI: 10.1016/0140-6736(91)92517-6. View

Murase N, Demetris A, Matsuzaki T, Yagihashi A, Todo S, Fung J . Long survival in rats after multivisceral versus isolated small-bowel allotransplantation under FK 506. Surgery. 1991; 110(1):87-98. PMC: 2975982. View

Grant D, Wall W, Mimeault R, Zhong R, Ghent C, Garcia B . Successful small-bowel/liver transplantation. Lancet. 1990; 335(8683):181-4. DOI: 10.1016/0140-6736(90)90275-a. View

Schroeder P, Goulet O, Lear P . Small-bowel transplantation: European experience. Lancet. 1990; 336(8707):110-1. DOI: 10.1016/0140-6736(90)91621-g. View

Starzl T, Todo S, Tzakis A, Alessiani M, Casavilla A, Abu-Elmagd K . The many faces of multivisceral transplantation. Surg Gynecol Obstet. 1991; 172(5):335-44. PMC: 2655210. View

10.

Murase N, Demetris A, Kim D, Todo S, Fung J, Starzl T . Rejection of multivisceral allografts in rats: a sequential analysis with comparison to isolated orthotopic small-bowel and liver grafts. Surgery. 1990; 108(5):880-9. PMC: 3032401. View

11.

Clark C, Cunningham A, Crane P, Wood R, Lear P . Lymphocyte infiltration patterns in rat small-bowel transplants. Transplant Proc. 1990; 22(6):2460. View

12.

Lear P, Cunningham A, Clark C, Crane P, Wood R . What role for passenger leucocytes in small-bowel allografts?. Transplant Proc. 1990; 22(6):2463. View

13.

Goulet O, Revillon Y, Jan D, Brousse N, De Potter S, Cerf-Bensussan N . Small-bowel transplantation in children. Transplant Proc. 1990; 22(6):2499-500. View

14.

Jaffe R, Trager J, Zeevi A, Duquesnoy R, Todo S, Rowe M . Multivisceral intestinal transplantation: surgical pathology. Pediatr Pathol. 1989; 9(6):633-54. PMC: 2972733. DOI: 10.3109/15513818909022372. View

15.

Starzl T, Todo S, Tzakis A, Podesta L, Mieles L, Demetris A . Abdominal organ cluster transplantation for the treatment of upper abdominal malignancies. Ann Surg. 1989; 210(3):374-85; discussion 385-6. PMC: 1358006. DOI: 10.1097/00000658-198909000-00013. View

16.

Tzakis A, Todo S, Starzl T . Orthotopic liver transplantation with preservation of the inferior vena cava. Ann Surg. 1989; 210(5):649-52. PMC: 1357802. DOI: 10.1097/00000658-198911000-00013. View

17.

Starzl T, Rowe M, Todo S, Jaffe R, Tzakis A, Hoffman A . Transplantation of multiple abdominal viscera. JAMA. 1989; 261(10):1449-57. PMC: 3005343. View

18.

Breiter H, CRAIG R, LeVee G, Atkinson Jr A . Use of kinetic methods to evaluate D-xylose malabsorption in patients. J Lab Clin Med. 1988; 112(5):533-43. View

19.

Fung J, Zeevi A, Kaufman C, Paradis I, Dauber J, Hardesty R . Interactions between bronchoalveolar lymphocytes and macrophages in heart-lung transplant recipients. Hum Immunol. 1985; 14(3):287-94. DOI: 10.1016/0198-8859(85)90236-8. View

20.

Lillehei R, Idezuki Y, Feemster J, Dietzman R, KELLY W, Merkel F . Transplantation of stomach, intestine, and pancreas: experimental and clinical observations. Surgery. 1967; 62(4):721-41. View