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Query: UMLS:C0018133 (graft-versus-host disease)
 18,032 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Gut transplantation is at a stage comparable to that of transplantation of the heart and liver in the late 1960s. The feasibility of this procedure has been demonstrated in large animals but has not been successful in clinical practice. Rejection, sepsis, and possible GVHD are the major obstacles. Ongoing clinical trials can be justified on the basis of the limited options that are available for patients with the short gut syndrome who develop complications while on TPN, the improved results in animals studies, the recent clinical success of pancreaticoduodenal transplantation, and the demonstrated ability to detect rejection and remove the intestinal graft without mortality (Table 1).
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PMID:Intestinal transplantation: current status. 265 Mar 91

Small bowel transplantation is a logical treatment in patients with the short bowel syndrome. The intestinal function can be permanently reestablished in animals with small bowel autografts. However, small bowel allotransplantation involves a considerable risk of immunological problems because of the large quantity of lymphoid tissue present in the graft. In non-immunosupprimized experimental animals, it triggers a vigorous rejection response and/or graft versus host disease (GVHD). The use of azathioprine and prednisone as immunosuppression has improved the graft survival minimally. The advent of cyclosporine has increased the survival of small bowel allografts in animal experiments considerably. Preoperative graft irradiation reduces the risk of GVHD. Monitoring of graft function is difficult. Histological evaluation of intestinal biopsy specimens is very useful and it can be combined with the determination of the absorptive function by 14C labelled carbohydrates (glucose, maltose). Twelve patients have undergone small bowel transplantation during the period 1964-1987. Eleven patients died a few weeks after the small bowel transplantation, the longest survivor died after 76 days (information is not available about the last small bowel transplanted patient). Four patients were treated with cyclosporine. Although the results so far have been depressing, a fundament has been created for further investigation in the field. Today, small bowel transplantation is an experimental treatment. It should only be considered for patients with serious and immediately life-threatening complications of the short bowel syndrome.
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PMID:[Small bowel transplantation. Animal experimental and clinical status]. 266 Mar 77

Small bowel transplantation (SBT) would, in theory, be the treatment of choice for patients suffering from the short bowel syndrome. Although SBT has been done with a considerable degree of success in some centers [36, 145], it is by no means an established or widely applicable therapy for those with short bowel syndrome. The small bowel is unique among vascularized organ grafts because it not only elicits a vigorous rejection reaction but is also capable of inducing graft-versus-host disease (GVHD). Rejection of the graft does not only lead to loss of function but also to bacterial translocation. The risk of fatal sepsis is aggravated by the immunosuppression given to prevent rejection. Here, the history of SBT is described, and recent developments in experimental and clinical SBT, as well as future prospects for this theoretically optimal treatment modality for patients dependent on total parenteral nutrition (TPN) for life, are outlined.
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PMID:Small bowel transplantation: an overview. 811 3

Total parenteral nutrition (TPN) is used routinely to maintain patients with the Short Bowel Syndrome (SBS). Until recently, TPN has been the only available therapeutic modality for patients with SBS. Currently, it is the treatment of choice for such individuals and occasionally, when the loss of bowel is extensive, it may be the only way of maintaining life. Unfortunately, TPN is expensive and markedly restrains an individual's lifestyle. Despite the overall success of TPN, the numerous risks associated with its use and the many complications of having an intravenous indwelling for years have served as the stimulus for alternative treatments such as small bowel transplantation (SBT). The first attempts at small bowel transplantation in clinical medicine were by Detterling almost 25 years ago. Patient death or graft loss in these early attempts was caused by the failure to control graft rejection and/or the inability to prevent Graft Versus Host Disease (GVHD). A stimulus for renewed clinical interest in SBT was provided by Starzl et al in 1988 with a report of prolonged graft survival without graft rejection or GVHD in a patient who was the recipient of a multivisceral graft consisting of the entire small bowel and other abdominal organs. Since 1964, 78 Small Bowel transplants have been performed in humans. Several variations of the multivisceral procedure in which the liver and the small bowel constitute the major components of the graft were adopted. The longest survival has been in a child who is still alive with a working graft for more than two years, as reported by Goulet from Paris in 1989. The introduction in SBT of the new immunosuppressive agent FK 506 had provided results which are superior to those achieved with Cyclosporine A (CsA). This latter observation prompted the Pittsburgh group to initiate a large series of isolated and composite intestinal grafts. The remarkable results have demonstrated the clinical utility of intestinal transplantation. This paper will try to summarize the history of the small bowel transplantation until the end of the year 1992, with the current progress in use today.
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PMID:Small bowel transplantation: current progress and clinical application. 871 29

Octreotide inhibits intestinal motility and secretions of the gastro-intestinal tract and pancreas and mediators of diarrhoea and so is very useful in managing refractory diarrhoea. It is safe and effective in 75-80% of the 10-20% of cancer chemotherapy patients who develop severe diarrhoea, and is useful in the management of persistent diarrhoea associated with neuroendocrine tumours, particularly VIPoma and carcinoid tumours, congenital microvillus atrophy, some patients with the short bowel syndrome (giving them a reduced need for intravenous fluids), and AIDS-related diarrhoea that does not respond to antibiotics or conventional anti-diarrhoeal drugs. Some studies suggest a 50% effectiveness in graft-versus-host disease. Preliminary studies suggest that octreotide is also of value in persistent diarrhoea caused by neuromuscular disorders of the gut, particularly diabetes mellitus and systemic sclerosis, suggesting that it may have wider application in the future. Octreotide may prove useful as a tool for studying the pathogenesis of diarrhoea of diverse aetiologies, particularly those associated with disturbances of intestinal motility, such as irritable bowel syndrome.
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PMID:The role of somatostatin analogues in the treatment of refractory diarrhoea. 881 86

An 8-month-old child with an immunodeficiency disorder characterized by abnormal lymphocyte function and by low IgG and IgA levels had combined liver and small bowel transplantation under tacrolimus and steroid immunosuppression for the treatment of short gut syndrome and hepatic cirrhosis. The patient developed an early postoperative episode of Pneumocystis carinii pneumonia, and a subsequent surgical complication, prompting discontinuance of tacrolimus. A skin rash eventually shown to be graft-versus-host disease (GVHD) developed in the flank on the 12th post-transplant day and gradually became generalized. Peritonitis, sepsis, multisystem organ failure including the liver allograft led to death on the 23rd post-operative day. The mechanisms leading to post-transplant GVHD under the specific circumstances in this case are discussed.
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PMID:Graft-versus-host disease after liver and small bowel transplantation in a child. 936 21

Intestinal transplantation has emerged as a feasible alternative in the treatment of children with short gut syndrome. The challenges in the management of these patients include maintaining a tight balance between the degree of immunosuppression necessary to prevent graft-versus-host disease and rejection. At the same time, this amount of immunosuppression is associated with a high risk for lymphoproliferative disorders and intestinal-derived sepsis. Current 3-year patient and graft survival rates are 55% and 50%, respectively. The indications, morbidity, and timing for referral are discussed.
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PMID:Intestinal transplantation for children with short bowel syndrome. 1132 11

The short bowel syndrome is caused by the anatomical or functional loss of more than 75% of the small bowel. These patients are currently dependent upon long-term total parenteral nutrition (TPN), a treatment that has made much progress, but which is not devoid of complications and which alters the quality of life. Transplantation of a new bowel is the only curative treatment for this disease. But intestinal transplantation (Itx) is not yet considered as an alternative to TPN. Itx is rendered difficult by the immunological obstacles, in particular a vigorous rejection response and the capacity of the bowel graft to induce a graft-versus-host disease (GVHD). Currently only profound and chronic immunosuppression is capable of controling this alloimmune response, but this is at the cost of infection, lymphoma and direct drug toxicity. For this reason Itx is currently rarely performed and usually seen as a "last chance" treatment for terminal patients with life-threatening complications of TPN. The last 10 years, there has been much research performed on Itx. Rejection and GVHD have been better characterized in small and large animal models. Some mechanisms of this alloimmune response have been delineated. Reproducible surgical techniques have been developed in large animal models. Immunomodulatory strategies have been developed that can help to control rejection and reduce the need for immunosuppression. The lessons learned from these experiments--in particular the surgical models that were developed and the immunomodulatory strategies that were designed--were applied in a clinical Itx programme. In October 2000 and in June 2002, 2 Itx were performed in patients with a short bowel syndrome and life-threatening liver failure caused by TPN. Both patients are doing well and have developed no episode of rejection or GVHD so far. This is despite the fact that they are receiving extremely low immunosupppression for this type of transplant. Currently those 2 patients are physically completely rehabilitated and can eat normally again.
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PMID:[Intestinal transplantation from the laboratory to the clinic]. 1531 20

This paper reviews the research that has been conducted into the use of Sandostatin to control the debilitating symptoms of diarrhea in a number of different etiologies. These are cancer-related diarrheas, including diarrhea related to chemotherapy, radiotherapy, neuroendocrine tumor carcinoid syndrome, vasoactive intestinal peptide-secreting tumors and also non-cancer related diarrhea, including short bowel syndrome, ileo- and jejunostomy, dumping syndrome, graft versus host disease and AIDS-related diarrhea. There is an increasing recognition of the need to balance the cost of care with patient outcome. It is becoming clear that although the cost of a therapeutic regimen with Sandostatin is substantially greater than the current non-specific therapy, the overall cost is potentially greater without the use of Sandostatin for patients with refractory diarrhea due to the inevitable need for further treatment and/or hospitalization with intravenous fluid supplementation. Initial trials and reports from preclinical testing and clinical practice have shown promising results and, although in the majority of cases they strengthen the view taken in the published consensus guidelines for the use of Sandostatin for refractory diarrhea, further, larger scale, comparative clinical trials are required for any evidence-based definition of dosage and efficacy as a treatment or prophylactic agent to combat and control diarrhea.
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PMID:Diarrhea and the rationale to use Sandostatin. 2045 47

Intestinal transplant (IT) is one of the least common forms of organ transplant but is increasing both in volume of cases and number of centers performing intestinal transplants, with the busiest centers in North America and Europe. IT can be performed in isolation or as part of a multivisceral transplant (MVT). Intestinal failure either in the form of short gut syndrome or functional bowel problems is the primary indication for IT. The normal post-surgical anatomy can be variable due to both recipient anatomy in regard to amount of residual bowel and status of native vasculature as well as whether the transplant is isolated or part of a multivisceral transplant. Complications of isolated IT and IT as part of an MVT include complications shared with other types of organ transplants such as infection, rejection, post-transplant lymphoproliferative disorder and graft versus host disease. Mechanical bowel complications of the graft include bowel obstruction, stricture, leak, perforation and enterocutaneous fistula. Lastly, vascular complications of both the venous and arterial anastomoses including stricture and pseudoaneurysm occur.
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PMID:Intestinal transplants: review of normal imaging appearance and complications. 2977 Jul 6


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