Chapter 29 – Small Bowel Transplantation

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1、CHAPTER29SMALLBOWELTRANSPLANTATIONAbigailE.MartinandDebraL.Sudanaccess.AsmorepatientsweresustainedforlongerperiodswithhistoryTPN,cholestasisleadingtoliverfailurewasincreasinglyrecog-nontransplantationtherapiesforshortbowel3nizedasapotentiallyfatalcomplicatio

2、n.Untilrecently,syndrometransplantationordeathappearedtobeinevitableonceaindicationsforintestinaltransplantationpatientdevelopedparenteralnutrition–associatedliverdiseaseevaluation(PNALD).However,anewinvestigationalfishoil–basedlipidanatomicconsiderationsfor

3、mulationhasbeenreportedtopreventorevenreverseTPN-4immunosuppressioninducedcholestasis,andmaybethenextmajorbreakthroughmonitoringandrejectioninthisfield.complicationsEarlyinvestigationalmodelsofintestinaltransplantationwerebeingdevelopedlongbeforetheadventofT

4、PN,butwereoutcomesdoomedtofailurebecauseofalackofunderstandingofimmu-conclusionsnology.ThefirstinvestigationofintestinaltransplantationasnoveltherapyforintestinalfailureisattributedtoAlexisCarrel5in1905.Approximately50yearslater,in1959,aftertheearli-estsucce

5、ssfulkidneytransplantationinBoston,Lilleheiand6colleaguesattheUniversityofMinnesotapublishedtheirsuc-cessfulworktransplantingintestinesusingacaninemodel.HISTORY7StarzlandassociatesinPittsburghreportedtransplantingaDiseaseprocessesthatleadtoaninabilitytosusta

6、inoneselfviaclusteroforgans,includingtheintestine,indogsin1960.Thenormalenteralnutritionremainatherapeuticchallengetofirstpublishedhumanintestinaltransplantationwasperformed8patientsandphysiciansalike.ThetermsshortgutsyndromeandbyLilleheiandcoworkersin1967,b

7、utthepatientunfortu-shortbowelsyndromeareoftenusedtodescribepatientswhoarenatelydidnotsurvivebecauseofthromboemboliccomplica-dependentontotalparenteralnutrition(TPN)becauseofsig-tions.Overthenextfewyears,therewereseveralother9nificantlossofbowellengthfromava

8、rietyofcauses,rangingunsuccessfulattemptsinhumans,primarilybecauseofthefromcongenitalmalformationstotraumaticinjurytoischemicinabilitytocontrolrejection,resultinginoverwhelminginfec-loss.Priorto