Indications for Intestine transplantation in Adults

In contrast to the indications for intestine transplantation in children, the leading indications for intestine transplantation in adults are Crohn's disease and vascular insufficiency.

Crohn's Disease

Crohn's disease is a chronic inflammation of the intestinal that can involve multiple segments of the GI tract, although it usually appears in the ileocolonic area.[36] Disease may be severe and require multiple extensive bowel resections, resulting in dependence on TPN.

Intestinal Vascular Insufficiency

Intestinal vascular insufficiency may result from acute causes such as motor vehicle accidents, gunshot wounds, or other types of trauma or accidents. Vascular insufficiency due to mesenteric venous thrombosis may also be caused by hypercoagulable states such as factor V mutation, protein S or C deficiencies, or antithrombin III deficiency.[27] Although these disorders originate in the liver, patients develop thromboses within the splanchnic system requiring intestine transplantation for mesenteric venous hypertension rather than intestinal ischemia.[37,38] Patients with these deficiencies require combined liver-intestine transplantation. Diagnosis is confirmed through angiography and hypercoagulation tests. Budd-Chiari syndrome is another vascular abnormality that in extensive forms may indicate intestinal or multivisceral transplantation. This syndrome can have a wide range of presentations, from a veno-occlusive disorder with small vessel occlusion to thrombosis of the major hepatic veins and/or the inferior vena cava.[39]

Familial Adenomatous Polyposis (FAP)

Another disease seen more frequently in adults than children is FAP, an autosomal dominant disorder characterized by the progression and development of polyps in the large intestine.[40] FAP is a precancerous state necessitating a colectomy to avoid colon cancer. An associated disorder is Gardner's syndrome, a form of FAP that includes intestinal polyposis as well as soft-tissue tumors and osteomas of the mandible, skull, and long bones. A further complication of polyposis is the development of diffuse mesenteric fibromatosis or desmoid tumors.[40]

Radiation Damage

Radiation damage to the intestine may cause radiation enteritis, another indication for intestine transplantation. Patients present with bloody diarrhea and rectal bleeding, and subsequently develop malabsorption syndrome with protein-losing enteropathy. Inflammation, ulceration, and fistula formation are seen on endoscopy. The intestinal biopsy reveals villous atrophy with focal to progressive fibrosis.[20]


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