Our Summary

This article explores how biologicals (medicines made from living organisms) are used in intestinal transplants. These drugs have been employed for different reasons, such as preparing the body for transplantation, preventing and treating organ rejection, reducing inflammation, and treating a certain disease related to the Epstein-Barr virus that can occur after transplantation.

The use of certain biologicals, like antibodies that deplete T-cells and drugs that block the interleukin-2 receptor, has significantly improved the health of patients and the survival of transplanted organs.

New biologicals, which target B-cells, plasma cells, and components of the immune system called complements, have been effective in treating immune reactions that can damage a transplanted organ and threaten its long-term health.

Other conditions related to transplantation have been treated with antibodies against TNF-α, a protein that causes inflammation, such as infliximab.

In summary, biologicals have played a big role in improving the success of intestinal transplantation. Future advancements in this area are expected to help with various challenges in intestinal transplantation, including preimmunization, organ damage caused by antibodies and complements, and diseases caused by the body’s natural immune responses.

FAQs

  1. What role do biologicals play in intestinal transplantation?
  2. What are some of the indications for using biologicals in intestinal and multivisceral transplantation?
  3. What are some of the novel developments in the use of biologicals for intestinal transplantation?

Doctor’s Tip

One helpful tip a doctor might tell a patient about intestinal transplant is to follow a strict medication regimen, including any prescribed biologicals, to prevent rejection and ensure the long-term success of the transplant. It is important to communicate with your healthcare team about any side effects or concerns you may have while taking these medications. Additionally, maintaining a healthy lifestyle, including a balanced diet and regular exercise, can also support the functioning of the transplanted intestine. Regular follow-up appointments with your transplant team are essential to monitor your progress and address any issues that may arise.

Suitable For

Patients who are typically recommended for intestinal transplant are those with irreversible intestinal failure, often due to conditions such as short bowel syndrome, necrotizing enterocolitis, or motility disorders. These patients may have failed conventional medical treatments and require long-term parenteral nutrition. In some cases, patients may also have associated liver failure, necessitating a multivisceral transplant.

Additionally, patients with complications such as recurrent infections, central line-associated bloodstream infections, or liver disease related to parenteral nutrition may also be considered for intestinal transplant. Patients with specific indications for biological use, such as antibody-mediated rejection or posttransplant lymphoproliferative disease, may also benefit from intestinal transplant and the use of biological therapy.

Overall, intestinal transplant is considered for patients with severe intestinal failure who have exhausted other treatment options and have a high risk of morbidity and mortality without transplantation. The use of biological therapy in these patients can help improve outcomes and reduce the risk of rejection and complications post-transplant.

Timeline

Before Intestinal Transplant:

  1. Patient undergoes extensive medical evaluations to determine if they are a suitable candidate for intestinal transplant.
  2. Patient may need to undergo various pre-transplant treatments and therapies to prepare their body for surgery.
  3. Patient is placed on the transplant waiting list and waits for a suitable donor organ to become available.

After Intestinal Transplant:

  1. Patient undergoes the complex surgical procedure for intestinal transplant.
  2. Patient is closely monitored in the intensive care unit post-transplant to ensure the success of the surgery.
  3. Patient may experience complications such as rejection, infection, or graft failure, which will require immediate medical attention.
  4. Patient undergoes a long-term regimen of immunosuppressive medications to prevent rejection of the transplanted organ.
  5. Patient undergoes regular follow-up appointments and monitoring to ensure the health and function of the transplanted intestine.

What to Ask Your Doctor

  1. What specific biological medications will I be taking before and after the transplant?
  2. How will these biological medications help prevent rejection or treat complications post-transplant?
  3. What are the potential side effects or risks associated with these biological medications?
  4. How long will I need to take these biological medications after the transplant?
  5. Will I need to undergo any additional monitoring or testing while taking these biological medications?
  6. Are there any specific lifestyle changes or precautions I should take while on these biological medications?
  7. How often will I need to follow up with you or the transplant team after the transplant?
  8. What signs or symptoms should I watch for that may indicate a reaction to the biological medications?
  9. Are there any alternative treatment options to biological medications that I should consider?
  10. How successful have these biological medications been in improving patient and allograft outcomes in intestinal transplantation cases similar to mine?

Reference

Authors: Pascher A, Atanasov G. Journal: Curr Opin Organ Transplant. 2016 Apr;21(2):171-7. doi: 10.1097/MOT.0000000000000290. PMID: 26859221