Download PDF
Semin Liver Dis 2000; 20(4): 437-450
DOI: 10.1055/s-2000-13151
Copyright © 2000 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Liver and Small Bowel Transplantation: Therapeutic Alternatives for the Treatment of Liver Disease and Intestinal Failure

Richard Gilroy1 , Debra Sudan2
  • 1Division of Hepatology and Transplantation, University of Nebraska Medical Center, Omaha, Nebraska and
  • 2Organ Transplantation Program, University of Nebraska Medical Center, Omaha, Nebraska
Further Information

Publication History

Publication Date:
31 December 2000 (online)

    Permissions and Reprints

ABSTRACT

Intestinal transplantation is an established life-saving therapy for parenteral nutrition dependent patients suffering from severe complications of parenteral nutrition. Improvements in outcomes over the last decade have occurred with refinements in surgical technique, better immunosuppressive regimens, and clinical experience. The long-term results of intestinal transplantation are not well known and morbidity remains an important obstacle to wider application of this procedure to patients with short bowel syndrome (SBS). This article reviews the indications for intestinal transplantation, the evaluation of potential candidates, therapeutic considerations, postoperative management and common complications experienced by the recipients.

KEYWORD

small bowel transplant - intestinal transplant - intestinal failure - short bowel syndrome - TPN-induced liver dysfunction

REFERENCES

  • 1 Carrel A. The transplantation of organs. A preliminary communication.  JAMA . 1905;  45 1654
    PubMedSearch in Google Scholar
  • 2 Alican F, Hardy J D, Cayirli M. Intestinal transplantation: laboratory experience and report of a clinical case.  Amer J Surg . 1971;  121 150-159
    CrossrefPubMedSearch in Google Scholar
  • 3 Cohen Z, Silverman R E, Wassef R. Small intestinal transplantation using cyclosporine. Report of a case.  Transplantation . 1986;  42 613-621
    PubMedSearch in Google Scholar
  • 4 Lillehei R C, Idezuki Y, Feemster J A. Transplantation of stomach, intestine and pancreas: Experimental and clinical observations.  Surgery . 1967;  62 721-741
    PubMedSearch in Google Scholar
  • 5 Olivier G, Rettori R, Olivier C. Homotransplantation orthotopique de l'intestin grele et des colons droit et transverse chez l'homme.  J Chir . 1969;  98 331-40
    PubMedSearch in Google Scholar
  • 6 Ruiz J O, Lillehei R C. Intestinal Transplantation.  Surgical Clinics of North America . 1972;  52 1075-1091
    PubMedSearch in Google Scholar
  • 7 Wilmore D W, Groff D B, Bishop H C, Dudrick S J. Total parenteral nutrition in infants with catastrophic gastrointestinal anomalies.  J Pediatr Surg . 1969;  4 181-189
    CrossrefPubMedSearch in Google Scholar
  • 8 Shils M E, Wright W L, Turnbull A. Longterm parenteral nutrition through external arteriovenous shunt.  N Engl J Med . 1970;  283 341-344
    CrossrefPubMedSearch in Google Scholar
  • 9 Broviac J N, Scribner B H. Prolonged parenteral nutrition in the home.  Surg Gynecol Obstet . 1974;  139 24-248
    PubMedSearch in Google Scholar
  • 10 Howard L, Ament M, Fleming C R. Current use and clinical outcome of home parenteral and enteral nutrition therapies in the United States.  Gastroenterology . 1995;  109 355-365
    CrossrefPubMedSearch in Google Scholar
  • 11 Messing B, Lemann M, Landais P. Prognosis of patients with nonmalignant chronic intestinal failure receiving long-term home parenteral nutrition.  Gastroenterology . 1995;  108 1005-1010
    CrossrefPubMedSearch in Google Scholar
  • 12 Howard L, Malone M. Current status of home parenteral nutrition in the United States.  Transplant Proc . 1996;  28 2691
    PubMedSearch in Google Scholar
  • 13 Stokes M A, Irving M H. Mortality in patients on home parenteral nutrition.  JPEN . 1989;  13 172-175
    PubMedSearch in Google Scholar
  • 14 Cavicchi M, Beau P, Crenn P. Prevalence of liver disease and contributing factors in patients receiving home parenteral nutrition for permanent intestinal failure.  Ann Intern Med . 2000;  132 525-532
    PubMedSearch in Google Scholar
  • 15 Wasa M, Takagi Y, Sando K. Long-term outcome of short bowel syndrome in adult and pediatric patients.  JPEN . 1999;  23(Suppl) S110-S112
    PubMedSearch in Google Scholar
  • 16 Starzl T E, Rowe M I, Todo S. Transplantation of multiple abdominal viscera.  JAMA . 1989;  261 1449-1457
    CrossrefPubMedSearch in Google Scholar
  • 17 Williams J W, Sankary H N, Foster P F. Splanchnic Transplantation.  JAMA . 1989;  261 1458-1462
    CrossrefPubMedSearch in Google Scholar
  • 18 Goulet O J, Revillon Y, Cerf-Bensussan N. Small intestinal transplantation in a child using cyclosporine.  Transplant Proc . 1988;  20(Suppl 3) 288-296
    PubMedSearch in Google Scholar
  • 19 Grant D, Wall W, Mimeault R. Successful small bowel/liver transplantation.  Lancet . 1990;  335 181-184
    CrossrefPubMedSearch in Google Scholar
  • 20 Colomb V, De Potter S, Goulet O. Potential Candidates for small bowel transplantation in pediatric patients on home parenteral nutrition.  Transplant Proc . 1996;  28 2698
    PubMedSearch in Google Scholar
  • 21 Asfar S, Atkinson P, Ghent C. Small bowel transplantation: a life-saving option for selected patients with intestinal faliure.  Dig Dis Sci . 1996;  41 875-883
    PubMedSearch in Google Scholar
  • 22 Grant D. Intestinal transplantation: 1997 report of the international registry.  Transplantation . 1999;  67 1061-1064
    PubMedSearch in Google Scholar
  • 23 Scott N A, Irving M H. Intestinal failure-the clinical problem.  Dig Dis . 1992;  10 249-257
    PubMedSearch in Google Scholar
  • 24 Vanderhoof J, Langnas A. Short bowel syndrome in children and adults.  Gastroenterology. 1997; 
    PubMedSearch in Google Scholar
  • 25 Quigley E. Small intestinal transplantation: reflections on an evolving approach to intestinal failure.  Gastroenterology . 1996;  110 2009-2011
    PubMedSearch in Google Scholar
  • 26 Bowyer B A, Leming C R, Ludwig J. Does long-term home parenteral nutrition in adult patients cause chronic liver disease?.  JPEN . 1985;  9 11-17
    PubMedSearch in Google Scholar
  • 27 Nousia-Arvanitakis S, Angelopoulou-Sakadami N, Metroliou K. Complications associated with total parenteral nutrition in infants with short bowel syndrome.  Hepatogastroenterology . 1992;  39 169-172
    PubMedSearch in Google Scholar
  • 28 Colomb V, Goulet O, De Potter S, Ricour C. Liver disease associated with long-term parenteral nutrition in children.  Transplant Proc . 1994;  26 1467
    PubMedSearch in Google Scholar
  • 29 Sondheimer J, Asturias E, Cadnapaphornachai M. Infection and cholestasis in neonates with intestinal resection and long-term parenteral nutrition.  J Pediatric Gastroenterol Nutr . 1998;  27 131-137
    PubMedSearch in Google Scholar
  • 30 Chan S, McCowen K C, Bistrian B R. Incidence, prognosis, and etiology of end-stage liver disease in patients receiving home total parenteral nutrition.  Surgery . 1999;  126 28-34
    CrossrefPubMedSearch in Google Scholar
  • 31 Williams N, Scott N A, Irving M H. Catheter-related morbidity in patients on home parenteral nutrition: implications for small bowel transplantation.  Ann R Coll Surg Engl . 1994;  76 384-386
    PubMedSearch in Google Scholar
  • 32 Wolf A, Pohlandt F. Bacterial infection: The main cause of acute cholestasis in newborn infants receiving short-term parenteral nutrition.  J Pediatric Gastroenterol Nutr . 1989;  8 297-303
    PubMedSearch in Google Scholar
  • 33 Burnes J U, O'Keefe S, Fleming C R. Home parenteral nutrition- a 3-year analysis of clinical and laboratory monitoring.  JPEN . 1992;  16 327-32
    PubMedSearch in Google Scholar
  • 34 Broviac J S, Cole J J, Scribner B H. A silicone rubber right atrial catheter for prolonged parenteral alimentation.  Surg Gynecol Obstet . 1973;  136 602-606
    PubMedSearch in Google Scholar
  • 35 Flowers R H, Schwenzer K J, Kopel R F. Efficacy of an attachable subcutaneous cuff for the prevention of intravascular catheter-related infection.  JAMA . 1989;  261 878-883
    CrossrefPubMedSearch in Google Scholar
  • 36 Mermel L A. Prevention of intravascular catheter-related infections.  Ann Intern Med . 2000;  132 391-402
    CrossrefPubMedSearch in Google Scholar
  • 37 Howard L, Hassan N. Home parenteral nutrition 25 years later.  Gastroenterol Clin North Am . 1998;  27 481-512
    CrossrefPubMedSearch in Google Scholar
  • 38 Shike M, Harrison J E, Sturtridge W C. Metabolic bone disease in patients receiving long-term total parenteral nutrition.  Am Intern Med. 92 343-350
    PubMed
  • 39 Howard L, Heaphey L, Fleming C R. Four years of North American registry home parenteral nutrition outcome data and their implications for patient management.  JPEN . 1991;  15 384-393
    CrossrefPubMedSearch in Google Scholar
  • 40 Kosmach B, Tarbell S, Reyes J, Todo S. Munchausen by proxy syndrome in a small bowel transplant recipient.  Transplant Proc . 1996;  28 2790-2791
    PubMedSearch in Google Scholar
  • 41 Sudan D L, Kaufman S S, Shaw Jr W B. Isolated intestinal transplantation for intestinal failure.  Am J Gastroenterol . 2000;  95 1506-1515
    CrossrefPubMedSearch in Google Scholar
  • 42 Fishbein T, Schiano T, Jaffe D. Isolated intestinal Transplantation in adults with Non-Reconstructible GI Tract. VI International Small Bowel Transplant Symposium Omaha, Nebraska, USA. New York: The Recanati/ Miller Transplantation Institute, Mount Sinai Hospital; 1999
    Search in Google Scholar
  • 43 Iyer K R, Kaufman S, Sudan D. Long-term result of intestinal transplantation for pseudo-obstruction in children.  J Pediatr Surg (in press).
    PubMed
  • 44 Sigurdsson L, Reyes J, Kocoshis S A. Intestinal transplantation in children with chronic intestinal pseudo-obstruction.  Gut . 1999;  45 570-574
    PubMedSearch in Google Scholar
  • 45 Masetti M, Rodriguez M M, Thompson J F. Multivisceral transplantation for megacystis microcolon intestinal hypoperistalsis syndrome.  Transplantation . 1999;  68 228-232
    PubMedSearch in Google Scholar
  • 46 Horslen S P, Kaufman S S, Sudan D L. Isolated liver transplantation in infants with total parenteral nutrition associated end-stage liver disease.  Transplantation . 2000;  67 S589
    PubMedSearch in Google Scholar
  • 47 Lawrence J P, Dunn S P, Billmire D F. Isolated liver transplantation for liver failure in patients with short bowel syndrome.  J Pediatr Surg . 1994;  29 751-753
    CrossrefPubMedSearch in Google Scholar
  • 48 Gambarara M, Goulet O, Bagolan P. Long-term parenteral nutrition in the management of extremely short bowel syndrome.  Transplant Proc . 1998;  30 2539-2540
    CrossrefPubMedSearch in Google Scholar
  • 49 Sindhi R, Landmark J, Shaw J B. Combined liver/small bowel transplantation using a blood group compatible but nonidentical donor.  Transplantation . 1996;  61 1782-1783
    PubMedSearch in Google Scholar
  • 50 Todo S, Reyes J, Furukawa H. Outcome analysis of 71 clinical intestinal transplantations.  Ann Surg . 1995;  222 270-282
    PubMedSearch in Google Scholar
  • 51 Furukawa H, Kusne S, Abu-Elmagd K. Effect of CMV serology on outcome after clinical intestinal transplantation.  Transplant Proc . 1996;  28 2780-2781
    PubMedSearch in Google Scholar
  • 52 Reynolds D W, Stagno S, Reynolds R, Alford Jr A C. Perinatal cytomegalovirus infection: influence of placentally transferred maternal antibody.  J Infect Dis . 1978;  137 564-567
    PubMedSearch in Google Scholar
  • 53 Sindhi R, Fox I J, Heffron T. Procurement and preparation of human isolated small intestinal grafts for transplantation.  Transplantation . 1995;  60 771-773
    PubMedSearch in Google Scholar
  • 54 De Roover A, Langnas A. Surgical methods of small bowel transplantation.  Current Opinion in Organ Transplantation . 1999;  4 335-342
    CrossrefPubMedSearch in Google Scholar
  • 55 Shaffer D, Maki T, DeMichele S J. Studies in small bowel transplantation: prevention of graft versus host disease with preservation of allograft function by donor pretreatment with antilymphocyte serum.  Transplantation . 1988;  45 262-269
    PubMedSearch in Google Scholar
  • 56 Sudan D, Iyer K R, Deroover A. A new technique of combined liver-small bowel intestinal transplantation.  Transplantation [submitted].
    PubMed
  • 57 Karatzas T, Khan F, Tzakis A G. Clinical intestinal transplantation: experience in Miami.  Transplant Proc . 1997;  29 1787-1789
    CrossrefPubMedSearch in Google Scholar
  • 58 Reyes J, Bueno J, Kocoshis S. Current status of intestinal transplantation in children.  J Pediatr Surg . 1998;  33 243-254
    PubMedSearch in Google Scholar
  • 59 Lee R G, Nakamura K, Tsamandas A C. Pathology of human intestinal transplantation.  Gastroenterology . 1996;  110 1820-1834
    PubMedSearch in Google Scholar
  • 60 Timmermann W, Hoppe H, Gasser M. Noninvasive video microscopic monitoring of rat small bowel rejection.  Transplant Proc . 1998;  30 2660-2661
    CrossrefPubMedSearch in Google Scholar
  • 61 Kato T, O'Brien C B, Nishida S. The first case report of the use of a zoom videoendoscope for the evaluation of small bowel graft mucosa in a human after intestinal transplantation.  Gastrointest Endosc . 1999;  50 257-261
    PubMedSearch in Google Scholar
  • 62 Grant D, Lamont D, Zhong R. 51Cr-EDTA: a marker of early intestinal rejection in the rat.  J Surg Res . 1989;  46 507-514
    CrossrefPubMedSearch in Google Scholar
  • 63 Sigalet D L, Kneteman N M, Fedorak R N. Intestinal function following allogeneic small intestinal transplantation in the rat.  Transplantation . 1992;  53 264-271
    PubMedSearch in Google Scholar
  • 64 Abu-Elmagd K, Reyes J, Todo S. Clinical intestinal transplantation: new perspectives and immunologic considerations.  J Am Coll Surg . 1998;  186 512-527
    CrossrefPubMedSearch in Google Scholar
  • 65 Sudan D L, Kaufman S, Horslen S. Incidence, timing, and histologic grade of acute rejection in small bowel transplant recipients.  Transplant Proc . 2000;  32 1199
    CrossrefPubMedSearch in Google Scholar
  • 66 Kusne S, Furukawa H, Abu-Elmagd K. Infectious complications after small bowel transplantation in adults: an update.  Transplant Proc . 1996;  28 2761-2762
    PubMedSearch in Google Scholar
  • 67 Green M, Reyes J, Nour B. Early infectious complications of liver-intestinal transplantation in children: preliminary analysis.  Transplant Proc . 1994;  26 1420-1421
    PubMedSearch in Google Scholar
  • 68 Manez R, Kusne S, Green M. Incidence and risk factors associated with the development of cytomegalovirus disease after intestinal transplantation.  Transplantation . 1995;  59 1010-1014
    PubMedSearch in Google Scholar
  • 69 Nalesnik M A, Jaffe R, Starzl T E. The pathology of posttransplant lymphoproliferative disorders occurring in the setting of cyclosporine A-prednisone immunosuppression.  Am J Pathol . 1988;  133 173-192
    PubMedSearch in Google Scholar
  • 70 Nalesnik M, Reyes J, Mazieriegos G. Posttransplant Lymphoproliferative Disorders (PTLD) in Small Bowel Allograft Recipients. VI International Small Bowel Transplant Symposium. Omaha, Nebraska, USA. Pittsburgh, Pennsylvania: Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center; 1999
  • 71 Gross T G, Hinrichs S H, Winner J. Treatment of post-transplant lymphoproliferative disease (PTLD) following solid organ transplantation with low-dose chemotherapy [letter].  Ann Oncol . 1998;  9 339-340
    CrossrefPubMedSearch in Google Scholar
  • 72 Reyes J, Green M, Bueno J. Epstein Barr virus associated posttransplant lymphoproliferative disease after intestinal transplantation.  Transplant Proc . 1996;  28 2768-2769
    PubMedSearch in Google Scholar
  • 73 Pirenne J, Gruessner A C, Benedetti E. Donor-specific unmodified bone marrow transfusion does not facilitate intestinal engraftment after bowel transplantation in a porcine model.  Surgery . 1997;  121 79-88
    CrossrefPubMedSearch in Google Scholar
  • 74 Matsumoto S, Tanaka S, Orita K. Effect of donor pretreatment on graft-versus-host disease (GVHD) after rat small-bowel transplantation (SBTX).  Transplant Proc . 1994;  26 2306-2308
    PubMedSearch in Google Scholar
  • 75 Wisecarver J L, Cattral M S, Langnas A N. Transfusion-induced graft-versus-host disease after liver transplantation. Documentation using polymerase chain reaction with HLA- DR sequence-specific primers.  Transplantation . 1994;  58 269-271
    PubMedSearch in Google Scholar
  • 76 Bacigalupo A, van Lint T M, Frassoni F. High dose bolus methylprednisolone for the treatment of acute graft versus host disease.  Blut . 1983;  46 125-132
    PubMedSearch in Google Scholar
  • 77 Rovera G M, DiMartini A, Schoen R E. Quality of life of patients after intestinal transplantation.  Transplantation . 1998;  66 1141-1145
    PubMedSearch in Google Scholar
  • 78 Sudan D, Iversen A, Weseman R. Assessment of function, growth and development, and long-term quality of life after small bowel transplantation.  Transplant Proc . 2000;  32 1211-1212
    CrossrefPubMedSearch in Google Scholar
  • 79 Abu-Elmagd K M, Reyes J, Fung J J. Evolution of clinical intestinal transplantation: improved outcome and cost effectiveness.  Transplant Proc . 1999;  31 582-584
    CrossrefPubMedSearch in Google Scholar
  • 80 Reyes J, Fishbein T, Bueno J. Reduced-size orthotopic composite liver-intestinal allograft.  Transplantation . 1998;  66 489-492
    PubMedSearch in Google Scholar
  • 81 de Ville de Goyet J, Mitchell A, Mayer A D. En block combined reduced-liver and small bowel transplants: from large donors to small children.  Transplantation . 2000;  69 555-559
    PubMedSearch in Google Scholar
  • 82 Sigalet D L, Williams D C, Garola R. Impact of FK506 and steroids on adaptation after intestinal resection or segmental transplantation.  Pediatr Transplant . 2000;  4 12-20
    CrossrefPubMedSearch in Google Scholar
  • 83 Muiesan P, Dhawan A, Novelli M. Isolated liver transplant and sequential small bowel transplantation for intestinal failure and related liver disease in children.  Transplantation . 2000;  69 2323-2326
    PubMedSearch in Google Scholar
  • 84 Carson K L, Hunt C M. Medical problems occurring after orthotopic liver transplantation.  Dig Dis Sci . 1997;  42 1666-1674
    CrossrefPubMedSearch in Google Scholar