Intestinal transplantation: evolution and current status

• Autor(a) principal: Cunha-Melo,Jose Renan
• Data de Publicação: 2014
• Outros Autores: Costa,Guilherme
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: MedicalExpress (São Paulo. Online)
• Texto Completo: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S2358-04292014000600307
• topic: Intestinal transplantation; Gastrointestinal rehabilitation; Multivisceral transplantation

Despite early disappointments, the three main types of visceral transplantation (isolated intestine, liver intestine, and multivisceral) have evolved into the standard of care for patients with nutritional failure and complex abdominal pathology. Visceral allografts have been assessed in clinical, radiological, endoscopic, and histopathologic studies. Absorptive functions of engrafted intestine have been assessed by body weight, body mass index, and z scores, serum levels of albumin, vitamins, and trace elements, as well as measurements of bone mineral density. Allograft rejection, infection, and renal failure, are the leading causes of death. Additionally, nonfunctional social support and progression of primary disease contribute to mortality rates beyond the fiveand ten-year follow-up landmarks. Remote events, including acute rejection, post-transplant lymphoproliferative disorder, and graft-versus-host-disease were significantly higher in pediatric recipients. Adult recipients experience higher incidences of de novo malignancy, primary disease recurrence, and impaired skeletal health. The leading causes of death are graft failure, complications of therapy, post-transplant lymphoproliferative disorder, progression of primary disease, and others, such as substance abuse, suicide and lack of support. Health status was sustained with successful interventions to treat hypertension, diabetes, osteoporosis, and renal failure. In spite of disease recurrence and long-term immunosuppression-related morbidities, the health status of most survivors has been sustained with successful interventions to treat occurring co-morbidities. With continual improvement in early survival and long-term rehabilitative efficacy, visceral transplantation should be considered a better therapeutic option for patients with severe intestinal failure.