Medical course and complications after visceral transplantation

Abstract

Surgical innovations and standardization of surgical techniques combined with advances in immunosuppression and induction protocols, improved understanding of gut physiology and mucosal immunology, and improved transplant medical management, including monitoring for possible complications, have now led to the possibility of successful intestinal transplantation. The main types now performed include isolated intestinal transplantation which may or may not include the colon, combined liver-intestine transplantation, and multivisceral transplantation which along with the small intestine may include any combination of the stomach, large intestine, liver, spleen, and, especially in patients with cystic fibrosis, chronic pancreatitis, or type 1 diabetes mellitus, the pancreas. Multivisceral transplantation is a very complex procedure that presents multiple challenges for proper post-transplantation management, with a substantial risk of complications including rejection, infection, de novo malignancy, renal dysfunction, and graft-versus-host disease. Such medical complications combined with the demands on patients for adherence -not only to taking medications as directed but also to hygiene rules, specific dietary regimens, and other health behaviors -and long-term management of all other aspects of chronic illness can result in significant anxiety, depression, and emotional distress requiring psychosocial and mental health care. A team approach including transplant surgeons, gastroenterologists, infectious disease specialists, child development specialists, and occupational, speech, and physical therapists as well as mental health clinicians is absolutely required.