2013 - ISBTS 2013 Symposium

This page contains exclusive content for the member of the following sections: TTS, IXA, ITA. Log in to view.

Posters and Exhibition

15.57 - India's first successful intestinal transplant: the road traveled and the lessons learnt

Presenter: Ravi, Mohanka, , India
Authors: A S Soin1, Ravi Mohanka1, N Saraf1, A Rastogi1, S Goja1, B Menon1, S Saigal1, R Sud1, D Kumar1, S Ramachandra1, P Bhangui1, P Singla1, K Raghvendra1, Kareem M Abu Elmagd2

India’s first successful intestinal transplant: the road traveled and the lessons learnt

A S Soin1, Ravi Mohanka1, N Saraf1, A Rastogi1, S Goja1, B Menon1, S Saigal1, R Sud1, D Kumar1, S Ramachandra1, P Bhangui1, P Singla1, K Raghvendra1, Kareem M Abu Elmagd2

1Medanta Institute of Liver Transplant and Regenerative Medicine, Medanta, Gurgaon, India; 2Department of Surgery, Intestinal Transplant Centre, Cleveland Clinic, Cleveland, OH, United States

 

Intestinal transplant is one of the most complex operations; not just medically and surgically, but also logistically because of the expertise and resources required. A large proportion of patients who undergo massive bowel resection and develop intestinal failure have poor outcome, because of inability to sustain long-term TPN and limited availability of intestinal and multi-visceral transplantation facilities. We report the first successful isolated intestinal transplant from India.
 
Case: A 27 year old gentleman, software engineer underwent massive bowel resection except about 30 cm of small bowel due to mesenteric vein thrombosis 4 years ago. After resection, he was on TPN through chemoport. Over next 2 years, he had 7 episodes of line sepsis, two of which were potentially life-threatening. Over 4 years, he lost about 35 kgs of weight, had poor quality of life and developed suicidal tendencies. He was evaluated and wait-listed for an isolated intestinal transplant.
 
The donor was a 21 year old gentleman who died of head injury in a road traffic accident in the same city. He was hemodynamically stable with normal hematology, biochemistry and serology except raised sodium of 162 mmol/L. The intestinal was accepted after negative T and B cell lymphocytic cross match and correction of sodium to 152 mmol/L and retrieved using UW solution in the standard fashion.
 
In the recipient, adhesiolysis was done, distal ileal remnant and proximal half of colon were resected. Under Thymoglobulin induction, intestinal graft was implanted with inflow from infra-renal aorta and outflow into portal vein using vascular conduits, with uniform reperfusion. Bowel continuity was established by jejuno-ileal and ileo-colic two layer anastomoses, leaving a 20 cm ‘chimney ileostomy’.
 
He had a steady post-operative recovery with routine hematology, biochemistry and ileal biopsies. He was given enteral feeds at 2 weeks and oral diet at 3 weeks after transplant when TPN was stopped. He had 2 episodes of rejection in the first month, one of which was treated with steroids and another with Thymoglobulin. After discharge, he had chylous ascites which resolved with MCT diet followed by TPN.
 
Conclusion: The case demonstrates successful management of intestinal failure for 4 years on T/PPN followed by deceased donor isolated intestinal transplantation for the first time in India. Specialized nutrition units to manage long-term TPN, expertise in intestinal transplantation, standardization of peri-operative management protocols, and sensitization of deceased donor retrieval centres about ideal intestine donors is essential for future success in this field.

Important Disclaimer

By viewing the material on this site you understand and accept that:

  1. The opinions and statements expressed on this site reflect the views of the author or authors and do not necessarily reflect those of The Transplantation Society and/or its Sections.
  2. The hosting of material on The Transplantation Society site does not signify endorsement of this material by The Transplantation Society and/or its Sections.
  3. The material is solely for educational purposes for qualified health care professionals.
  4. The Transplantation Society and/or its Sections are not liable for any decision made or action taken based on the information contained in the material on this site.
  5. The information cannot be used as a substitute for professional care.
  6. The information does not represent a standard of care.
  7. No physician-patient relationship is being established.

Social

Contact

Staff Directory
+1-514-874-1717
info@tts.org

Address

The Transplantation Society
International Headquarters
740 Notre-Dame Ouest
Suite 1245
Montréal, QC, H3C 3X6
Canada

Info

Privacy Policy
Terms of Use
Copyright Notice