Our Summary

This research paper examines the complex role of the immune system in intestinal transplants, which are among the most complicated types of abdominal organ transplants. The body’s immune response, both in terms of its general responses (innate immunity) and specific responses (adaptive cellular immunity), is key to improving the outcomes of these transplants and expanding their use for patients with intestinal failure.

The paper discusses recent discoveries in several areas. These include the effect of antibodies that are specific to the donated organ on the success of the transplant; the role of a protein called NOD2 in regulating the immune response in the intestines; the protective role of cells involved in the general immune response (innate lymphoid cells); and the role of a type of immune cell called Th17 in the body’s rejection of the transplanted organ. Understanding these aspects could help improve the success rate of intestinal transplants.

FAQs

  1. What is the role of humoral and innate and adaptive cellular immunity in intestinal transplantation?
  2. What are the recent findings about the impact of donor-specific antibodies on intestinal allografts?
  3. What is the role of Th17 cells in acute cellular rejection during intestinal transplantation?

Doctor’s Tip

One helpful tip a doctor might tell a patient about intestinal transplant is to closely follow their immunosuppressive medication regimen as prescribed. These medications are crucial for preventing rejection of the transplanted intestine. It is important to take all medications at the correct times and doses to ensure the best possible outcome. Additionally, patients should also follow a healthy diet and lifestyle to support the functioning of the transplanted intestine. Regular follow-up appointments with the transplant team are also important for monitoring progress and addressing any concerns.

Suitable For

Patients who are typically recommended for intestinal transplant are those suffering from intestinal failure, which can result from a variety of conditions including short bowel syndrome, motility disorders, chronic intestinal pseudo-obstruction, and severe inflammatory bowel disease. These patients may be dependent on parenteral nutrition and/or experiencing frequent complications such as infections, liver failure, and poor quality of life. Intestinal transplantation may be considered as a potential treatment option for these patients when other medical interventions have failed to provide adequate nutrition and improve overall health.

Timeline

Before Intestinal Transplant:

  1. Patient is diagnosed with intestinal failure, which may be caused by conditions such as short bowel syndrome, inflammatory bowel disease, or intestinal ischemia.
  2. Patient undergoes extensive medical and nutritional management to try to improve intestinal function.
  3. Patient may require total parenteral nutrition (TPN) to receive essential nutrients intravenously.
  4. Patient may experience complications such as infections, liver dysfunction, and malnutrition due to intestinal failure.
  5. Patient is evaluated for intestinal transplantation as a potential treatment option.

After Intestinal Transplant:

  1. Patient undergoes a thorough evaluation process to assess their suitability for transplantation.
  2. Patient is placed on the transplant waiting list and waits for a suitable donor organ to become available.
  3. Patient undergoes the transplant surgery, which involves removing the diseased intestine and replacing it with a healthy donor intestine.
  4. Patient is closely monitored in the hospital for any signs of rejection or complications.
  5. Patient undergoes intensive immunosuppressive therapy to prevent rejection of the transplanted organ.
  6. Patient undergoes regular follow-up appointments and monitoring to ensure the success of the transplant and manage any complications that may arise.
  7. Patient may require ongoing medical management and support to maintain the health of the transplanted intestine.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with intestinal transplantation?
  2. How long is the recovery process after an intestinal transplant?
  3. What medications will I need to take after the transplant and what are the potential side effects?
  4. How often will I need to follow up with my transplant team after the surgery?
  5. What lifestyle changes will I need to make after the transplant to ensure its success?
  6. What are the success rates of intestinal transplants and what factors can affect the outcome?
  7. How will my immune system be affected by the transplant and what measures will be taken to prevent rejection?
  8. Are there any alternative treatment options to intestinal transplantation that I should consider?
  9. What support services are available to help me cope with the emotional and physical challenges of the transplant process?
  10. How long can an intestinal transplant be expected to last and are there any long-term considerations I should be aware of?

Reference

Authors: Kroemer A, Cosentino C, Kaiser J, Matsumoto CS, Fishbein TM. Journal: Curr Gastroenterol Rep. 2016 Nov;18(11):56. doi: 10.1007/s11894-016-0530-0. PMID: 27645751