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Transplant Services

UCLA offers range of therapeutic options for patients with intestinal failure

07/27/2010

CUP-Intestianl FailureThe UCLA Intestinal Rehabilitation and Transplantation Program offers expert diagnosis and comprehensive care for patients with intestinal failure from a variety of disorders. UCLA is among the leaders in treating intestinal failure patients, and has the largest intestinal transplant program in the western U.S. UCLA has performed more than 100 intestinal transplant surgeries and has survival rates that are equal to or better than those of any other center in the world.

TPN

Total parenteral nutrition (TPN) is a form of liquid intravenous nutrition that replaces the function of the small bowel by delivering calories and nutrients directly into the circulatory system. When well tolerated, TPN can provide a long-term solution to short bowel syndrome. However, some intestinal failure patients develop complications of TPN, including liver disease, clotting of the veins at the catheter site and recurrent infections in the catheter lines. These patients can have major electrolyte and fluid balance problems and their care in rare cases is so complex that it can’t be managed at home.

Full range of therapies

The Intestinal Rehabilitation and Transplantation Program offers a full range of therapeutic options for intestinal failure patients. UCLA physicians provide expert TPN management, following the most current standards to ensure patients receive the maximum benefit from their nutrition while enjoying a life as unimpeded by their treatment as possible. UCLA is among the few centers in the country that can offer TPN formulations based on Omega-3 lipids instead of the standard Omega-6 formu- lation. Early reports indicate that the Omega-3 formulation is associated with a lower incidence of liver disorders. UCLA is conducting controlled studies and can offer patients the new formulation, which may be of particular benefit to pediatric patients.

Program physicians provide medical and surgical therapies to enhance intestinal adaptation — increasing the functional capacity of the remaining bowel segment to compensate for its short length. Medical strategies include changing nutritional formulations to ones requiring less digestion, and using medications — including glutamines and growth hormones — to enhance adaptation. Surgical therapies include autologous intestinal reconstructive surgery (intestinal lengthening), including serial transverse enteroplasty (STEP) in appropriate patients.

Intestinal transplantation

Patients who don’t adequately adapt and fail to tolerate long-term TPN may be candidates for intestinal transplantation. Advances in surgical technique, immunosuppression and infection control continue to make intestinal trans- plantation a safer procedure, but it still should be offered only to patients who are at high risk for poor outcomes with TPN.

The transplant procedure is tailored to meet individual patient needs. There are four basic types of transplants involving the small bowel:
Isolated intestinal transplant. This transplantation of the small bowel, including the jejunum and ileum, is used for patients who have intestinal failure with normal liver function or reversible liver disease.
Combined liver and intestinal transplant. This surgery is appropriate for patients with intestinal failure and irreversible liver disease.
Multivisceral transplant. This surgery includes the liver, stomach, duodenum, pancreas and small bowel and is appropriate for patients with diffuse diseases of the gastrointestinal tract associated with liver disease.
Modified multivisceral transplant. A multivisceral transplant that does not include the liver, and the stomach may or may not be included.
Outcomes for small bowel transplantation have improved rapidly, thanks in large part to the experience gained in transplanting other organs. Much of what has been learned in 40 years of transplanting other organs has been applied to small bowel transplantation.

Causes of Intestinal Failure

Intestinal failure (also commonly called Short Bowel Syndrome) — the inability to sustain nutritional and caloric needs via the intestinal tract — is associated with the following conditions:

Adult

  • Mesenteric vascular ischemia
  • Inflammatory bowel disease (Crohn’s)
  • Mesenteric vascular trauma
  • Intestinal volvulus
  • Intestinal pseudo-obstruction (CIPS)
  • Hereditary polyposis (Gardner’s syndrome)
  • Desmoid tumor of mesentery
  • Extensive surgical resection for other causes 


Pediatric 

  • Intestinal volvulus
  • Intestinal pseudo-obstruction (CIPS)
  • Gastroschisis
  • Intestinal atresia
  • Microvillous inclusion disease
  • Aganglionosis
  • Necrotizing enterocolitis


Team Members

Douglas G. Farmer, M.D.
Professor of Surgery, Division of Liver
and Pancreas Transplantation
Director, UCLA Intestinal Transplant Program
Surgical Director, Intestinal Rehabilitation
and Transplantation Program

Ronald W. Busuttil, M.D., Ph.D.
Professor and Chief
Department of Surgery
Director, Dumont-UCLA Transplant Center

Sue V. McDiarmid, M.D.
Professor, Division of Pediatric Gastroenterology
Director, Dumont-UCLA Pediatric Liver
Transplant Program

Robert S. Venick, M.D.
Assistant Clinical Professor
Division of Pediatric Gastroenterology

Johanna Colangelo, R.N.
Senior Transplant and CIRT Coordinator

Contact Information

Patients should ideally be referred early to help prevent them from needing transplants or, if transplantation is indicated, to get them listed early for organ transplantation so the surgery can be performed before the disease advances and health deteriorates.

(310) 267-9612
(310) 825-5318
Information and referral
(310) 267-0392 Fax
www.transplants.ucla.edu





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