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KEY FACTS
Terminology
Imaging
Clinical Issues
TERMINOLOGY
Abbreviations
- Small bowel transplantation (SB Tx)
Indications for SB Tx
- Life-threatening complications related to total parenteral nutrition (TPN)
- ≥ 2-line infections/year, 1 x fungal infection, septic shock, acute respiratory distress syndrome (ARDS), associated liver disease, venous thrombosis of central vessels, pulmonary embolism, ↑ fluid loss
- Primarily for short gut syndrome but also other causes of intestinal failure
- SB length or function insufficient to provide adequate nutrition
- Result of various etiologies
- Superior mesenteric arterial (SMA) or venous (SMV) thrombosis with bowel ischemia, Crohn disease, midgut volvulus, familial polyposis/Gardner (especially with mesenteric desmoids)
- Much less commonly due to intestinal pseudoobstruction or other functional deficiency of SB
- Result of various etiologies
- Patients can be maintained on TPN indefinitely, except for complications
- Lack of central venous access to administer TPN, TPN catheter-related sepsis, and TPN-induced cholestatic liver disease
- SB length or function insufficient to provide adequate nutrition
- Indications for multivisceral Tx (liver, ± pancreas, ± part of stomach)
- Advanced liver disease due to TPN or unrelated cause (e.g., chronic hepatitis)
- Advanced pancreatic disease
- Extensive mesenteric thrombosis (with multivisceral ischemia)
- Severe mesenteric neuropathy
- Special considerations for SB Tx
- Donor intestine contains large number of immunocompetent lymphocytes (↑ immunogenic) in bowel wall (e.g., Peyer patches) and mesenteric nodes
- ↑ prevalence of graft-vs.-host and graft rejection
- Donor intestine contains large number of bacteria and other potential pathogens
- ↑ prevalence of postoperative infections
- Early diagnosis by imaging of graft-related complications helps to ↓ morbidity and mortality
- Donor intestine contains large number of immunocompetent lymphocytes (↑ immunogenic) in bowel wall (e.g., Peyer patches) and mesenteric nodes
- Life-threatening complications related to total parenteral nutrition (TPN)
IMAGING
General Features
Radiographic Findings
Imaging Recommendations
MR Findings
Ultrasonographic Findings
CLINICAL ISSUES
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Selected References
- Kroemer A et al: Operational tolerance in intestinal transplantation. Am J Transplant. 21(2):876-82, 2021
- Kesseli S et al: Small bowel transplantation. Surg Clin North Am. 99(1):103-16, 2019
- Kubal CA et al: Challenges with intestine and multivisceral re-transplantation: importance of timing of re-transplantation and optimal immunosuppression. Ann Transplant. 23:98-104, 2018
- Ruiz P: Updates on acute and chronic rejection in small bowel and multivisceral allografts. Curr Opin Organ Transplant. 19(3):293-302, 2014
- van Dijk G et al: Liver, pancreas and small bowel transplantation: current ethical issues. Best Pract Res Clin Gastroenterol. 28(2):281-92, 2014
- Selvaggi G et al: Intestinal and multivisceral transplantation: future perspectives. Front Biosci. 12:4742-54, 2007
- Lauro A et al: Results of intestinal and multivisceral transplantation in adult patients: Italian experience. Transplant Proc. 38(6):1696-8, 2006
- Loinaz C et al: Bacterial infections after intestine and multivisceral transplantation. The experience of the University of Miami (1994-2001). Hepatogastroenterology. 53(68):234-42, 2006
- Oltean M et al: Infectious complications after multivisceral transplantation in adults. Transplant Proc. 38(8):2683-5, 2006
- Lauro A et al: Twenty-seven consecutive intestinal and multivisceral transplants in adult patients: a 4-year clinical experience. Transplant Proc. 37(6):2679-81, 2005
- Pecchi A et al: Radiologic imaging of the transplanted bowel. Abdom Imaging. 30(5):548-63, 2005
- Scarsbrook AF et al: Post-transplantation lymphoproliferative disorder: the spectrum of imaging appearances. Clin Radiol. 60(1):47-55, 2005
- Unsinn KM et al: Spectrum of imaging findings after intestinal, liver-intestinal, or multivisceral transplantation: part 2, posttransplantation complications. AJR Am J Roentgenol. 183(5):1285-91, 2004
- Tzakis AG et al: Intestinal transplantation: advances in immunosuppression and surgical techniques. Transplant Proc. 35(5):1925-6, 2003
- Unsinn KM et al: Spectrum of imaging findings after pediatric liver transplantation: part 1, posttransplantation anatomy. AJR Am J Roentgenol. 181(4):1133-8, 2003
- Unsinn KM et al: Spectrum of imaging findings after pediatric liver transplantation: part 2, posttransplantation complications. AJR Am J Roentgenol. 181(4):1139-44, 2003
- Martin D et al: Patient profile and candidacy for intestinal transplantation at the University of Pittsburgh. Transplant Proc. 34(5):1897-8, 2002
- Karatzas T et al: Clinical intestinal transplantation: experience in Miami. Transplant Proc. 29(3):1787-9, 1997
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Clinical Issues
TERMINOLOGY
Abbreviations
- Small bowel transplantation (SB Tx)
Indications for SB Tx
- Life-threatening complications related to total parenteral nutrition (TPN)
- ≥ 2-line infections/year, 1 x fungal infection, septic shock, acute respiratory distress syndrome (ARDS), associated liver disease, venous thrombosis of central vessels, pulmonary embolism, ↑ fluid loss
- Primarily for short gut syndrome but also other causes of intestinal failure
- SB length or function insufficient to provide adequate nutrition
- Result of various etiologies
- Superior mesenteric arterial (SMA) or venous (SMV) thrombosis with bowel ischemia, Crohn disease, midgut volvulus, familial polyposis/Gardner (especially with mesenteric desmoids)
- Much less commonly due to intestinal pseudoobstruction or other functional deficiency of SB
- Result of various etiologies
- Patients can be maintained on TPN indefinitely, except for complications
- Lack of central venous access to administer TPN, TPN catheter-related sepsis, and TPN-induced cholestatic liver disease
- SB length or function insufficient to provide adequate nutrition
- Indications for multivisceral Tx (liver, ± pancreas, ± part of stomach)
- Advanced liver disease due to TPN or unrelated cause (e.g., chronic hepatitis)
- Advanced pancreatic disease
- Extensive mesenteric thrombosis (with multivisceral ischemia)
- Severe mesenteric neuropathy
- Special considerations for SB Tx
- Donor intestine contains large number of immunocompetent lymphocytes (↑ immunogenic) in bowel wall (e.g., Peyer patches) and mesenteric nodes
- ↑ prevalence of graft-vs.-host and graft rejection
- Donor intestine contains large number of bacteria and other potential pathogens
- ↑ prevalence of postoperative infections
- Early diagnosis by imaging of graft-related complications helps to ↓ morbidity and mortality
- Donor intestine contains large number of immunocompetent lymphocytes (↑ immunogenic) in bowel wall (e.g., Peyer patches) and mesenteric nodes
- Life-threatening complications related to total parenteral nutrition (TPN)
IMAGING
General Features
Radiographic Findings
Imaging Recommendations
MR Findings
Ultrasonographic Findings
CLINICAL ISSUES
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Selected References
- Kroemer A et al: Operational tolerance in intestinal transplantation. Am J Transplant. 21(2):876-82, 2021
- Kesseli S et al: Small bowel transplantation. Surg Clin North Am. 99(1):103-16, 2019
- Kubal CA et al: Challenges with intestine and multivisceral re-transplantation: importance of timing of re-transplantation and optimal immunosuppression. Ann Transplant. 23:98-104, 2018
- Ruiz P: Updates on acute and chronic rejection in small bowel and multivisceral allografts. Curr Opin Organ Transplant. 19(3):293-302, 2014
- van Dijk G et al: Liver, pancreas and small bowel transplantation: current ethical issues. Best Pract Res Clin Gastroenterol. 28(2):281-92, 2014
- Selvaggi G et al: Intestinal and multivisceral transplantation: future perspectives. Front Biosci. 12:4742-54, 2007
- Lauro A et al: Results of intestinal and multivisceral transplantation in adult patients: Italian experience. Transplant Proc. 38(6):1696-8, 2006
- Loinaz C et al: Bacterial infections after intestine and multivisceral transplantation. The experience of the University of Miami (1994-2001). Hepatogastroenterology. 53(68):234-42, 2006
- Oltean M et al: Infectious complications after multivisceral transplantation in adults. Transplant Proc. 38(8):2683-5, 2006
- Lauro A et al: Twenty-seven consecutive intestinal and multivisceral transplants in adult patients: a 4-year clinical experience. Transplant Proc. 37(6):2679-81, 2005
- Pecchi A et al: Radiologic imaging of the transplanted bowel. Abdom Imaging. 30(5):548-63, 2005
- Scarsbrook AF et al: Post-transplantation lymphoproliferative disorder: the spectrum of imaging appearances. Clin Radiol. 60(1):47-55, 2005
- Unsinn KM et al: Spectrum of imaging findings after intestinal, liver-intestinal, or multivisceral transplantation: part 2, posttransplantation complications. AJR Am J Roentgenol. 183(5):1285-91, 2004
- Tzakis AG et al: Intestinal transplantation: advances in immunosuppression and surgical techniques. Transplant Proc. 35(5):1925-6, 2003
- Unsinn KM et al: Spectrum of imaging findings after pediatric liver transplantation: part 1, posttransplantation anatomy. AJR Am J Roentgenol. 181(4):1133-8, 2003
- Unsinn KM et al: Spectrum of imaging findings after pediatric liver transplantation: part 2, posttransplantation complications. AJR Am J Roentgenol. 181(4):1139-44, 2003
- Martin D et al: Patient profile and candidacy for intestinal transplantation at the University of Pittsburgh. Transplant Proc. 34(5):1897-8, 2002
- Karatzas T et al: Clinical intestinal transplantation: experience in Miami. Transplant Proc. 29(3):1787-9, 1997
