2013 - ISBTS 2013 Symposium

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Oral Communications 4

21.314 - A novel method for testing the function of the terminal ileum (TI) in small bowel transplant (SBTx) recipients

Presenter: Sue V., Beath, , United Kingdom
Authors: Sue V. Beath¹, Elsie Lanchbury², Helen Alton³, Ravinder Mahandru², Martin Toy², Indra van Mourik¹, Patrick McKiernan¹, Jane Hartley¹, Deirdre Kelly¹, Khalid Sharif¹, Girish Gupte¹

A novel method for testing the function of the terminal ileum (TI) in small bowel transplant (SBTx) recipients

Sue V. Beath¹, Elsie Lanchbury², Helen Alton³, Ravinder Mahandru², Martin Toy², Indra van Mourik¹, Patrick McKiernan¹, Jane Hartley¹, Deirdre Kelly¹, Khalid Sharif¹, Girish Gupte¹

¹The Liver Unit (including Small Bowel Transplantation), Birmingham Children's Hospital, Birmingham, United Kingdom; ²Nuclear Medicine/ Radiology Department, Queen Elizabeth Hospital, Birmingham, United Kingdom; ³Radiology Department, Birmingham Children's Hospital, Birmingham, United Kingdom

Introduction

Reliably detecting pathology in the TI without resorting to mucosal biopsy would be helpful in SBTx recipients. Measuring the re-absorption of bile salts in the TI using a radio-isotope of selenium attached to the bile salt Taurocholate (SeHCAT) is a direct physiological test of the health of the TI.

Subjects and methods

4 children aged 5-12yrs who had received SBTx (recovering from PTLD=3 and acute rejection (ACR)=1) were studied. 2/4 had stoma reversal. One further child (15yrs) with progressive familial intrahepatic cholestasis (PFIC) who had undergone a biliary diversion because of pruritis after liver transplantation, was a disease control. SeHCAT capsule was given orally; a baseline whole body gamma camera scan was done 4 hours later; subsequent measurements were taken days 1 - 5; the stoma bag was also scanned.

Results

The normal bile salt retention detected by gamma camera at 3 days is 30-70% of the baseline count [1], however the results in children with a stoma were very low (0%; 5%). One child with a reversed stoma who had cleared EBV viraemia had retention close to the reference range (25.5%), but not in the child who was receovering from ACR (15%). The child with PFIC + biliary diversion had an initial very high retention into the stoma bag suggesting excellent re-absorption of bile salts from his terminal ileum, however 3 day retention was 0.6% demonstrating good function of the biliary diversion.

Discussion

SeHCAT tests the integrity of the enterohepatic circulation (EHC) and is widely available in adult gastroenterology. These results confirm that children with stomas malabsorb bile acids which can be ameliorated after stoma closure. SeHCAT was useful in demonstrating that the biliary diversion was working well and may be helpful in pre-operative assessment of abnormal EHC. The role of SeHCAT in SBTx requires further evaluation.

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