Official Sections CTRMS ISVCA IPITA IPTA ISODP IRTA IXA SPLIT TID

2013 - ISBTS 2013 Symposium


This page contains exclusive content for the member of the following sections: TTS, IXA, ITA

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.


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
This email address is being protected from spambots. You need JavaScript enabled to view it.

Address

The Transplantation Society
International Headquarters
505 Boulevard René-Lévesque Ouest
Suite 1401
Montréal, QC, H2Z 1Y7
Canada