Our Summary

This paper looks at patients who received a small intestine or multiple organ transplant and then experienced an infection from a virus called cytomegalovirus (CMV). The usual treatment for this infection is a drug called ganciclovir (GCV), but in some cases, the virus can resist this drug. The study found that a significant number of these transplant patients developed this resistant form of the virus, which often led to further health complications and sometimes even the failure of the new organ. Furthermore, patients who had the virus in their tissues were much more likely to have the resistant form of the virus. This suggests that patients receiving small intestine or multiple organ transplants might be at a higher risk of developing this resistant viral infection, compared to other organ transplant recipients.

FAQs

  1. What is the cytomegalovirus (CMV) and how does it affect patients who received a small intestine or multiple organ transplant?
  2. What is the usual treatment for CMV infections and how effective is it in patients who received transplants?
  3. Are small intestine or multiple organ transplant patients at a higher risk of developing a resistant CMV infection compared to other organ transplant recipients?

Doctor’s Tip

One helpful tip a doctor might tell a patient about intestinal transplant is to closely follow their medical team’s recommendations for antiviral medications and monitoring for infections such as CMV. It is important for patients to be vigilant about any signs of infection and to report them to their healthcare provider immediately. Additionally, patients should maintain a healthy lifestyle, including a balanced diet, regular exercise, and proper hygiene practices to help prevent infections and support the healing process after transplant surgery. Regular follow-up appointments and communication with the medical team are crucial for monitoring and managing any potential complications.

Suitable For

Patients who are typically recommended for intestinal transplant include those with:

  1. Short bowel syndrome: This condition occurs when a significant portion of the small intestine is missing or non-functional, leading to malabsorption of nutrients and fluids.

  2. Intestinal failure: This condition occurs when the intestines are unable to perform their normal functions, leading to the need for intravenous nutrition (parenteral nutrition) for an extended period of time.

  3. Chronic intestinal pseudo-obstruction: This condition is characterized by symptoms similar to a bowel obstruction, but without any physical blockage. It can lead to severe abdominal pain, bloating, and constipation.

  4. Intestinal dysmotility disorders: These are conditions where the muscles of the intestine do not function properly, leading to problems with digestion and elimination.

  5. Inflammatory bowel disease (IBD): Severe cases of Crohn’s disease or ulcerative colitis that do not respond to medical treatment may require intestinal transplant as a last resort.

  6. Intestinal tumors: Benign or malignant tumors in the intestines that cannot be surgically removed may require intestinal transplant.

  7. Recurrent infections or complications following previous abdominal surgeries: Patients who have had multiple surgeries on their intestines and continue to experience complications such as strictures, fistulas, or infections may benefit from intestinal transplant.

It is important to note that intestinal transplant is a complex and risky procedure, and patients must undergo a thorough evaluation to determine if they are suitable candidates for the surgery. Additionally, patients must be willing to adhere to strict medical management and follow-up care post-transplant to ensure the success of the procedure.

Timeline

Before intestinal transplant:

  • Patient undergoes extensive medical evaluations and tests to determine if they are a suitable candidate for a small intestine transplant
  • Patient is placed on a waiting list for a donor organ
  • Patient may experience symptoms of intestinal failure, such as severe diarrhea, dehydration, and malnutrition
  • Patient may require parenteral nutrition or intravenous feeding to sustain their health

After intestinal transplant:

  • Patient undergoes surgery to receive the new intestine
  • Patient is closely monitored in the hospital for signs of organ rejection or infection
  • Patient must take immunosuppressant medications to prevent rejection of the new organ
  • Patient may experience complications such as infections, side effects from medications, or organ rejection
  • Patient undergoes regular follow-up appointments and monitoring to ensure the success of the transplant
  • Patient may need to make significant lifestyle changes, such as adhering to a strict diet and avoiding certain activities to protect the new organ

What to Ask Your Doctor

  1. What is the likelihood of developing a cytomegalovirus (CMV) infection after receiving an intestinal transplant?
  2. What are the symptoms of CMV infection and how is it diagnosed?
  3. What is the standard treatment for CMV infection and what are the potential risks and side effects of the medication?
  4. How common is it for the virus to become resistant to ganciclovir (GCV) in intestinal transplant patients?
  5. What steps can be taken to prevent CMV infection or reduce the risk of developing the resistant form of the virus?
  6. What is the prognosis for patients who develop a resistant form of CMV infection after an intestinal transplant?
  7. Are there any alternative treatments or experimental therapies available for patients with resistant CMV infection?
  8. How often will I need to be monitored for CMV infection post-transplant?
  9. Are there any lifestyle changes or precautions I should take to reduce my risk of CMV infection?
  10. What resources or support services are available for patients dealing with CMV infection or complications after an intestinal transplant?

Reference

Authors: Timpone JG, Yimen M, Cox S, Teran R, Ajluni S, Goldstein D, Fishbein T, Kumar PN, Matsumoto C. Journal: Transpl Infect Dis. 2016 Apr;18(2):202-9. doi: 10.1111/tid.12507. PMID: 26853894