Our Summary

This research paper reviews methods for monitoring transplanted intestines. Transplanted intestines can cause a strong immune response in the body. After the transplant, doctors usually do a biopsy (taking a small piece of tissue for testing) through a temporary opening in the lower part of the small intestine. Later on, they do this biopsy through a colonoscopy, which is more difficult. So, the researchers are interested in finding other ways to monitor the transplanted intestine.

They have looked at several ways of doing this. These include biomarkers (measurable substances in the body that show disease or infection) and diagnostic tools. The tools they studied include granzyme B, perforin, fecal calprotectin, citrulline, donor-specific antibody, and zoom video endoscopy. Each of these methods can monitor a different part of the body’s response to the transplanted intestine.

However, it’s still hard to find a reliable, repeatable, and non-invasive method to monitor a transplanted intestine. Most of the current methods can only be used along with careful clinical observation. So far, doing a biopsy is still the best way to monitor a transplanted intestine.

FAQs

  1. What is the purpose of a graft biopsy in the early posttransplant period?
  2. What are some of the alternative methods being studied for monitoring intestinal allografts?
  3. Why is finding a noninvasive method for intestinal graft monitoring important and challenging?

Doctor’s Tip

One helpful tip a doctor might tell a patient about intestinal transplant is to follow the recommended surveillance protocol for monitoring the health of the transplanted intestine. This may include regular graft biopsies, blood tests for biomarkers, and other diagnostic tools to detect any signs of rejection or complications early on. It is important to work closely with your healthcare team and follow their guidance to ensure the long-term success of the transplant.

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, intestinal pseudo-obstruction, or inflammatory bowel disease. These patients may have failed other treatments such as parenteral nutrition or intestinal lengthening surgeries. Additionally, patients with complications such as recurrent infections, liver failure due to parenteral nutrition, or severe malnutrition may also be considered for intestinal transplant. Patients who are not candidates for multi-organ transplant due to factors such as age, comorbidities, or poor functional status may also be considered for intestinal transplant.

Timeline

  • Before intestinal transplant:
  1. Patient undergoes thorough medical evaluation to determine if they are a candidate for intestinal transplant.
  2. Patient is placed on the transplant waiting list and awaits a suitable donor match.
  3. Patient may undergo pre-transplant testing and preparation, including counseling and education about the transplant process.
  • After intestinal transplant:
  1. Patient undergoes surgery to receive the intestinal transplant.
  2. Patient is monitored closely in the early posttransplant period for signs of rejection or complications.
  3. Graft biopsies via a temporary ileostomy are performed for surveillance to detect rejection.
  4. Once enteral continuity is reestablished, graft biopsies via a colonoscopy may be performed for monitoring.
  5. Alternative methods for intestinal allograft monitoring, such as biomarkers and diagnostic tools, are explored.
  6. Patient continues to be monitored long-term for rejection, complications, and overall graft function.

What to Ask Your Doctor

  1. What is the process for surveillance of the intestinal allograft in the early posttransplant period?
  2. How often will I need to undergo graft biopsies via colonoscopy in the later posttransplant period?
  3. Are there alternative methods for monitoring the intestinal allograft other than graft biopsy?
  4. What biomarkers or diagnostic tools are currently being studied for use in intestinal allograft surveillance?
  5. How reliable are these alternative methods compared to graft biopsy?
  6. What are the risks and benefits associated with each monitoring modality?
  7. How will the results of these surveillance tests impact my posttransplant care and treatment plan?
  8. How often will I need to undergo monitoring tests after the transplant surgery?
  9. What signs or symptoms should I watch for that may indicate rejection or other complications with the intestinal allograft?
  10. Are there any lifestyle changes or precautions I should take to help prevent rejection of the intestinal allograft?

Reference

Authors: Lauro A, Marino IR, Matsumoto CS. Journal: Curr Opin Organ Transplant. 2016 Apr;21(2):165-70. doi: 10.1097/MOT.0000000000000279. PMID: 26741111