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Small Intestine Transplantation
Michael P. Federle, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        TERMINOLOGY

        • Abbreviations

          • Small bowel transplantation (SB Tx)
        • Indications for Small Bowel Transplantation

          • Primarily for "short gut syndrome," but also other causes of intestinal failure
            • Small bowel 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 small bowel
            • Patients can be maintained on total parenteral nutrition (TPN) indefinitely, except for complications
              • Lack of central venous access to administer TPN, TPN catheter-related sepsis, and TPN-induced cholestatic liver disease
          • Indications for multivisceral transplantation (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 small bowel transplantation
            • Donor intestine contains large number of immunocompetent lymphocytes 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

        IMAGING

        • General Features

          • Radiographic Findings

            • Imaging Recommendations

              • MR Findings

                • Ultrasonographic Findings

                  CLINICAL ISSUES

                  • Natural History & Prognosis

                    • Treatment

                      DIAGNOSTIC CHECKLIST

                      • Consider

                        Selected References

                        1. Ruiz P: Updates on acute and chronic rejection in small bowel and multivisceral allografts. Curr Opin Organ Transplant. 19(3):293-302, 2014
                        2. van Dijk G et al: Liver, pancreas and small bowel transplantation: current ethical issues. Best Pract Res Clin Gastroenterol. 28(2):281-92, 2014
                        3. Selvaggi G et al: Intestinal and multivisceral transplantation: future perspectives. Front Biosci. 12:4742-54, 2007
                        4. Lauro A et al: Results of intestinal and multivisceral transplantation in adult patients: Italian experience. Transplant Proc. 38(6):1696-8, 2006
                        5. 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
                        6. Oltean M et al: Infectious complications after multivisceral transplantation in adults. Transplant Proc. 38(8):2683-5, 2006
                        7. 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
                        8. Pecchi A et al: Radiologic imaging of the transplanted bowel. Abdom Imaging. 30(5):548-63, 2005
                        9. Scarsbrook AF et al: Post-transplantation lymphoproliferative disorder: the spectrum of imaging appearances. Clin Radiol. 60(1):47-55, 2005
                        10. 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
                        11. Tzakis AG et al: Intestinal transplantation: advances in immunosuppression and surgical techniques. Transplant Proc. 35(5):1925-6, 2003
                        12. 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
                        13. 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
                        14. Martin D et al: Patient profile and candidacy for intestinal transplantation at the University of Pittsburgh. Transplant Proc. 34(5):1897-8, 2002
                        15. Karatzas T et al: Clinical intestinal transplantation: experience in Miami. Transplant Proc. 29(3):1787-9, 1997
                        Related Anatomy
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                        References
                        Tables

                        Tables

                        KEY FACTS

                        • Terminology

                          • Imaging

                            • Clinical Issues

                              TERMINOLOGY

                              • Abbreviations

                                • Small bowel transplantation (SB Tx)
                              • Indications for Small Bowel Transplantation

                                • Primarily for "short gut syndrome," but also other causes of intestinal failure
                                  • Small bowel 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 small bowel
                                  • Patients can be maintained on total parenteral nutrition (TPN) indefinitely, except for complications
                                    • Lack of central venous access to administer TPN, TPN catheter-related sepsis, and TPN-induced cholestatic liver disease
                                • Indications for multivisceral transplantation (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 small bowel transplantation
                                  • Donor intestine contains large number of immunocompetent lymphocytes 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

                              IMAGING

                              • General Features

                                • Radiographic Findings

                                  • Imaging Recommendations

                                    • MR Findings

                                      • Ultrasonographic Findings

                                        CLINICAL ISSUES

                                        • Natural History & Prognosis

                                          • Treatment

                                            DIAGNOSTIC CHECKLIST

                                            • Consider

                                              Selected References

                                              1. Ruiz P: Updates on acute and chronic rejection in small bowel and multivisceral allografts. Curr Opin Organ Transplant. 19(3):293-302, 2014
                                              2. van Dijk G et al: Liver, pancreas and small bowel transplantation: current ethical issues. Best Pract Res Clin Gastroenterol. 28(2):281-92, 2014
                                              3. Selvaggi G et al: Intestinal and multivisceral transplantation: future perspectives. Front Biosci. 12:4742-54, 2007
                                              4. Lauro A et al: Results of intestinal and multivisceral transplantation in adult patients: Italian experience. Transplant Proc. 38(6):1696-8, 2006
                                              5. 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
                                              6. Oltean M et al: Infectious complications after multivisceral transplantation in adults. Transplant Proc. 38(8):2683-5, 2006
                                              7. 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
                                              8. Pecchi A et al: Radiologic imaging of the transplanted bowel. Abdom Imaging. 30(5):548-63, 2005
                                              9. Scarsbrook AF et al: Post-transplantation lymphoproliferative disorder: the spectrum of imaging appearances. Clin Radiol. 60(1):47-55, 2005
                                              10. 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
                                              11. Tzakis AG et al: Intestinal transplantation: advances in immunosuppression and surgical techniques. Transplant Proc. 35(5):1925-6, 2003
                                              12. 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
                                              13. 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
                                              14. Martin D et al: Patient profile and candidacy for intestinal transplantation at the University of Pittsburgh. Transplant Proc. 34(5):1897-8, 2002
                                              15. Karatzas T et al: Clinical intestinal transplantation: experience in Miami. Transplant Proc. 29(3):1787-9, 1997