Small bowel transplant no longer a treatment of last resort.Patients with small bowel small bowel n. See small intestine. failure who are dependent on total parenteral nutrition Total Parenteral Nutrition Definition Total parenteral nutrition (TPN) is a way of supplying all the nutritional needs of the body by bypassing the digestive system and dripping nutrient solution directly into a vein. (TPN TPN, in biochemistry, abbreviation for triphosphopyridine nucleotide, a coenzyme now usually called nicotinamide adenine dinucleotide phosphate, or NADP. ) historically have not been offered a combination liver/small intestine transplant until they have developed life-threatening complications, such as liver failure liver failure Clinical medicine Liver insufficiency that results in death, requires a liver transplant, or is characterized by recovery after encephalopathy, or while awaiting a transplant; also defined as a condition with ≥ 3 of following: albumin < 3. . But in a small study presented at the Digestive Disease Week Annual Meeting in May in San Francisco, CA, researchers reported that isolated small bowel transplant resulted in high graft and patient survival, suggesting that this approach can safely be offered to patients with irreversible intestinal failure. Between 1998 and 2001, 6 TPN-dependent children and 11 adults who had preserved liver function but who were not candidates for intestinal rehabilitation received 19 isolated small bowel grafts and immunosuppression immunosuppression Suppression of immunity with drugs, usually to prevent rejection of an organ transplant. Its aim is to allow the recipient to accept the organ permanently with no unpleasant side effects. with tacrolimus, reported Sander Florman, MD and colleagues at Mt. Sinai School of Medicine in New York City New York City: see New York, city. New York City City (pop., 2000: 8,008,278), southeastern New York, at the mouth of the Hudson River. The largest city in the U.S. . Starting in June 2000, all patients also received sirolimus and basiliximab. All patients survived transplantation, but 3 had graft rejection graft rejection Rejection Clinical immunology The constellation of defenses mounted by the immune system of the recipient of an allograft–eg kidney, liver, pancreas, etc, which compromise the continued viability of grafted tissue. Cf Graft. and 1 had graft thrombosis. Two were successfully retransplanted. Two patients died, 1 from intracranial hemorrhage and 1 from sepsis. The patient who died of sepsis and the 4 who lost their grafts did not receive sirolimus. In pediatric patients, actuarial 2-year graft survival was 50%, 2-year patients survival was 67%, and overall actuarial 2-year graft and patient survival was 70%, the researchers reported in a meeting abstract. Corresponding figures in adults were 78%, 90%, and 83%, respectively. "Isolated small bowel transplantation with tacrolimus and sirolimus-based immunosuppression can be performed in patients without TPN-related hepatic dysfunction with good patient and graft survival," Florman and associates wrote. "High patient and graft survival rates in adults now allow us to offer isolated small bowel transplantation to a broader population of patients with intestinal failure. We approach an era in which this therapy may be safely offered to patients with irreversible intestinal failure prior to the development of life-threatening complications of TPN." |
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