摘要:

Prevention and treatment of rejection is the most difficult and most important dilemma in clinical intestinal transplantation. Early detection of rejection and timely initiation of treatment are critically important for the treatment of intestinal transplant recipients. The recent introduction of daclizumab as a third agent to be administered with corticosteroids and tacrolimus for induction therapy has improved early postoperative outcomes. Although biochemical markers and functional tests have not been effective in monitoring rejection, the advanced technology of zoom endoscopy offers enhanced capabilities for more accurate evaluation of small bowel graft rejection and timely initiation of treatment. Once rejection progresses to the severe stage, it can seldom be reversed, and early graft enterectomy or retransplantation may afford the only means for survival.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

The potential advantages of living-related segmental small bowel transplantation include better matching; lessening the risk and severity of rejection; minimizing the need for immunosuppressive drugs and decreasing their side effects; protecting the intestinal integrity and preventing bacterial translocation; and obviating space limitations for grafts. In contrast, shorter lengths of bowel (segments) absorb less than entire intestines, and there is a small but definite risk of donation for the donor. The technical questions still being studied include the use of portal versus systemic drainage, the segment of intestine to be transplanted (ileum versus jejunum), and the need for an ostomy and the timing of its closure. The recent experience with living-related segmental transplants includes three at Tulane, a 4-year survivor in Kiel, Germany), and several others (for a total of about 15) in the United States, China, Japan, and England. There have been few transplants between identical twins; one at Stanford functioned for several years. Overall, the results have been good, but considerably more experience is needed before the exact role of this technique is completely established.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Throughout the final decade of the 20th century, the number of centers performing intestinal transplantation and the number of transplants performed annually increased in a linear fashion. One of the reasons for the proliferation of small bowel transplantations has been steadily improving patient survival over the course of the past decade. Factors responsible for improved survival have included better patient selection, changes in surgical approach, more assiduous graft monitoring, revised immunosuppression protocols, and pre-emptive therapy of Epstein-Barr virus infections.

ISSN:1087-2418    

出版商:OVID    

年代:2000

数据来源: OVID