The challenge of post-operative management of patients following intestinal transplantation
Intestinal transplantation, in particular recipients of combines liver and small bowel transplantations constitute some of the most challenging patients to manage following their transplant procedure. The early post operative period can be complicated by numerous factors, many of which were present pre-operatively, including chronic respiratory failure, renal failure and recurrent bouts of sepsis. Other problems such as post operative haemorrhage, infections, can occur as well. Rejection episodes are very common in recipients of intestinal transplants. Surveillance biopsies are performed in patients in the early post-transplant period to facilitate appropriate therapy. Immunosuppression typically consists of at least tacrolimus and steroids. Enteralfeeding is initiated as soon as bowel function returns and is advanced as tolerated.
After the early pre-operative period, other oppotunistic infections or diseases can appearmost commonly CMV and EPV.CMV infections are treated with ganciclovir, generally.
Many of the patients continue to have trouble following transplantation with fluid and electrolyte disturbances. This often requires the use of supplemental intravenous fluids even as an outpatient. Stomas in most transplant patients are closed within the first transplant year when possible.(AN Langnas, University of Nebraska Medical Center, Department of Transplantation, Omaha,USA)
- Copyright © 2021. Published by MOHAN Foundation
- Keywords: liver, small bowel, transplantation, EPV, CMV