Liver and Intestine Transplantation

Current management of short bowel syndrome (SBS) revolves around the use of home TPN (HPN). Complications include liver disease, catheter-related infections or occlusions, venous thrombosis, and bone disease. Patient survival with SBS on TPN is 86% and 75% at 2 and 5 years, respectively. Surgical management of SBS includes nontransplant surgeries such as serial transverse enteroplasty and reanastomosis. Small bowel transplant has become increasingly popular for management of SBS and is usually indicated when TPN cannot be continued. Posttransplant complications include graft-versus-host reaction, infections in an immunocompromised patient, vascular and biliary diseases, and recurrence of the original disease. Following intestinal-only transplants, patient and graft survival rate is 77% and 66% after 1 year. After 5 years the survival figures are 49% and 34%, respectively. Future improvements in survival and quality of life will enhance small bowel transplant as a viable treatment option for patients with SBS.

show abstract

“…Although GVHD has been fatal in a very few cases, the majority have been self-limiting, with spontaneous resolution [132].…”

Section: Graft-versus-host Disease (Gvhd)mentioning

confidence: 99%

“…Infection is the leading cause of morbidity and mortality in the intestine transplant recipient, accounting for up to 70% of deaths [118,132,133]. Therefore, a thorough preventive approach to infection control is essential to the care of this patient population.…”

Section: Graft-versus-host Disease (Gvhd)mentioning

confidence: 99%

Short Bowel Syndrome: Parenteral Nutrition Versus Intestinal Transplantation. Where Are We Today?

et al. 2007

View full text Add to dashboard Cite

show abstract

“…1–5 For the induction purposes, MP is usually administered intravenously immediately after the graft reperfusion at a high dose of 500–1000 mg. 3,5 Additionally, MP at high intravenous bolus doses of 1000 mg per day, administered over several days, is the first-line therapy for the treatment of acute liver graft rejection. 1,2,4 Despite a high degree of effectiveness, the large intravenous doses of MP are associated with substantial toxicities, sometimes with fatal consequences.…”

Section: Introductionmentioning

confidence: 99%

Hepatic immunosuppressive effects of systemically administered novel dextran–methylprednisolone prodrugs with peptide linkers in rats

Shaik

Agarwal

Parang

et al. 2012

Journal of Pharmaceutical Sciences

View full text Add to dashboard Cite

The hepatic immunosuppressive activities of two novel dextran prodrugs of methylprednisolone (MP) containing one (DMP1) or five (DMP5) amino acids as linkers were studied in rats. At various times (0–2 weeks) after intravenous administration of single 5-mg/kg (MP equivalent) doses of each prodrug or MP succinate (MPS), livers were isolated and immunologically stimulated ex vivo with lipopolysaccharide. The concentrations of tumor necrosis factor (TNF)-α in the outlet perfusate were then quantitated to assess immune response. Additionally, the concentrations of DMP1, DMP5, and/or MP were measured in the liver. MPS, DMP5, or DMP1 injections caused a maximum of 48.9%, 63.5%, or 85.7% decrease in the TNF-α secretion into the perfusate, with the time above the 50% inhibitory effect being <5, <24, or 120 h, respectively. Additionally, the area under the effect-time curve for DMP1 was 11- or 4-fold higher than that after the administration of MPS or DMP5, respectively. Relatively high concentrations of DMP1 were present in the liver even at the last sampling time of two weeks. These data suggest that a single intravenous dose of DMP1 produces an intense and sustained immunosuppression in the liver for a relatively long time, which may be useful in liver transplantation.

show abstract

Immunologic aspects of small bowel transplantation

Adams

1998

Transplantation Proceedings

View full text Add to dashboard Cite

Liver and Intestine Transplantation

Cited by 3 publications

References 40 publications

Short Bowel Syndrome: Parenteral Nutrition Versus Intestinal Transplantation. Where Are We Today?

Short Bowel Syndrome: Parenteral Nutrition Versus Intestinal Transplantation. Where Are We Today?

Hepatic immunosuppressive effects of systemically administered novel dextran–methylprednisolone prodrugs with peptide linkers in rats

Immunologic aspects of small bowel transplantation

Contact Info

Product

Resources

About