Intestinal Transplantation  

Oleh:

Fishbein, Thomas M.

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: The New England Journal of Medicine (keterangan: ada di Proquest) vol. 361 no. 10 (Sep. 2009), page 998-1008.
Topik: Intestinal; Transplantation

Ketersediaan

Perpustakaan FK Nomor Panggil: N08.K.2009.05 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Isi artikel

he results of intestinal transplantation have improved over the past decade. During this period, the number of intestinal transplant procedures performed in North America has increased by a factor of three.1 In 2008, a total of 185 intestinal transplantations were performed in the United States, and 221 patients were registered on the waiting list as of June 2009 (http://optn.transplant.hrsa.gov). Early attempts at transplantation were hindered by technical and immunologic complications that led to graft failure or death. As a result of recent surgical advances, control of acute cellular rejection, and a decrease in lethal infections, the rate of patient survival at 1 year now exceeds 90% at experienced centers. Although long-term follow-up data are still lacking, the role of intestinal transplantation in the treatment of patients with gut failure is becoming clearer. Parenteral nutrition is currently the primary maintenance therapy for patients in whom intestinal absorptive function has failed. Transplantation is offered to patients with irreversible gut failure who have one of three problems: complications of parenteral nutrition, an inability to adapt to the quality-of-life limitations posed by intestinal failure, or a high risk of death if the native gut is not removed (as in the case of unresectable mesenteric tumors or chronic intestinal obstruction). However, there is still controversy about exactly which patients should continue to receive parenteral nutrition and which should receive an intestinal transplant. This article explores the current indications for intestinal transplantation, the surgical procedures involved, our current understanding of the immunology of intestinal transplantation, the detection and treatment of complications, postoperative outcomes, and future applications.

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