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Small BowelTransplantation
Dr Nilay BiswasPost Graduate Resident
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Background
100 patients receive small bowel
transplants each year.
Between 60 and 70 are kids age 18and under.
Small bowel transplantation was first
attempted in humans in 1964.
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Small bowel transplant is thetransplantation of an intestinal allograft to
an individual with irreversible intestinal
failure.
The purpose of this transplant
is to restore intestinal function.
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Indications
Irreversible intestinal failure
not successfully managed by TPN
life-threatning complications whileon TPN
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Intestinal failure
In children
1. Necrotising enterocolitis
2. Gastroschisis
3. Volvulus4. intestinal atresia
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Intestinal failure
In adults
1. Crohns disease
2. Mesenteric vascular thrombosis
3. Trauma
4. Desmoid tumors
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Types of intestinal
transplantation
alone
along with liver
multivisceral (liver, pancreas,stomach, duodenum & colon )
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Types of donors
deceased donors
living donors
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Preoperative evaluation
Medical
Surgical
Immunologic
Psychosocial
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Surgical procedure
Isolated intestinal transplant
In living donor 200 cm of distal small bowelis used.
Inflow to the graft is via ileocolic artery
Outflow is via ileocolic vein
In deceased donor graft is based onsuperior mesenteric artery for inflow andon the superior mesenteric vein for outflow
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Surgical procedure
Combined liver and intestinal transplant
Graft is procured intact with an aorticconduit containing both celiac and
superior mesenteric arteries
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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
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Surgical procedure
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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 graftmucosa
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Problems
Immunologically small intestine is the most
dificult organ to transplant
Monitoring for rejection is difficult
Bacterial translocation
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Contraindications
Life expectancy of less than five years due to age-related debilitation and co-morbiditiesAbility to ingest oral nutrition
Unresectable malignancySerious, uncontrolled psychiatric illness that wouldhinder compliance with any stage of the transplantprocessNeurologic illness independent of the diseaseprocess being treated
Drug or alcohol addiction
HIV (positive)
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Contraindications
Active and / or life-threatening infection
Severe body / organ system diseaseunrelated to transplanted organ
Compromised cardio-pulmonary functionunrelated to transplanted organ
Inability or unwillingness of the individual or
legal guardian to give signed consent andto comply with regular follow-uprequirements
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