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Intestinal Transplant

Intestinal Transplant - Indications

  • Irreversible Intestinal Failure with one or more of the following:
    • Liver failure due to long-term parenteral nutrition.
    • More than two episodes of catheter-related infection requiring hospitalization in one year.
    • A single episode of fungal line infection.
    • Frequent episodes of dehydration due to intestinal dysfunction.
    • Splanchnic venous thrombosis.
    • Unresectable benign or slow-growing mesenteric tumors.

Key Facts about Intestinal Transplant

  • Most Common Indication in Pediatrics: Gastroschisis
  • Most Common Indication in Adults: Ischemia
  • Cold Ischemia Time: 6-8 hours (shortest among solid organ transplants)
  • Rejection: Increased rate of rejection compared to other organ transplants.

Complications of Intestinal Transplantation

  • Rejection:
    • Diagnosed via ileoscopy and biopsy.
    • Presence of donor-specific antibodies may indicate rejection.
  • Most Common Cause of Graft Loss:
    • Infection (bacterial).
  • Most Common Viral Infection:
    • CMV enteritis.
  • EBV (Epstein-Barr Virus):
    • Can lead to Post-Transplant Lymphoproliferative Disorder (PTLD).
    • Intestinal transplant patients have the highest risk of PTLD.
    • Treatment: Reduction of immunosuppression and Rituximab.
  • Graft Versus Host Disease (GVHD):
    • Occurs in about 9% of cases.
    • Not seen in Liver Tx