https://onlinelibrary.wiley.com/doi/pdf/10.1111/ajt.12979

Intestinal transplant registry report: global activity and trends.

Intestinal transplantation has evolved from an experimental procedure with limited success to standard of care for patients with intestinal and parenteral nutrition failure, achieving outcomes commensurate with other solid-organ transplants (Grant et al. 2005; Fishbein 2009). Paramount to achieving the success of intestinal and multivisceral organ transplant procedures has been the refinement of donor organ procurement and transplantation techniques (Fishbein et al. 2003a). Early graft failures and deaths due to technical and donor-related complications have been minimized using the techniques described here, leaving the current challenge largely of optimizing immunologic and infection management strategies (Fishbein 2004; Fishbein and Matsumoto 2005). The techniques depicted here are those of choice in our experience, though mention is made of alternative techniques that others may prefer (Abu-Elmagd et al. 2000; Fishbein et al. 2003b; Reyes et al. 1998; Tzakis et al. 1993). Because patients requiring intestinal transplantation often present with multiple organ failure and require multiorgan transplantation, modification of these techniques may be required to meet the needs of an individual patient. Some of the modifications that we have encountered include the addition of renal allotransplantation, inclusion of the colon in a small-bowel or multivisceral graft, and modified multivisceral transplantation with preservation of the native liver. Intimate description of all possible technical variations that might be required is beyond the scope of this chapter, and intestinal transplant surgeons should be prepared to draw from their experience in gastrointestinal and transplant surgery and employ generally accepted tenets as necessary.

Intestinal and Multivisceral Transplantation

https://onlinelibrary.wiley.com/doi/pdf/10.1111/ajt.12812

The current state of intestine transplantation: indications, techniques, outcomes and challenges.

Background and Objective: Microvillous inclusion disease (MVID) is a rare congenital enterocyte disorder causing severe diarrhea and intestinal failure. The objective of this study was to analyze clinical evolution and the most frequent complications of MVID in children receiving parenteral nutrition (PN) and after small-bowel transplantation (SBTx) with the aim to improve treatment strategies and prognosis. Patients and Methods: From 1995 to 2009, 24 patients (16 boys, median follow-up 4.7 years, range: from birth to 23.5 years) with MVID were admitted to our unit. The recorded parameters included growth, neurological development, liver and renal functions, bone disease, and outcome. Results: Almost half of the children were from consanguineous families from the Mediterranean area. All of the patients completely depended on PN. Four children died of PN complications before 4 years of age. Before or without SBTx, growth failure was common (mean height −2.5 standard deviations [SD]), as was developmental delay (12/24), liver (20/22 with fibrosis) or kidney disease (3/23 with moderate renal insufficiency), and osteoporosis (6/24). Thirteen children underwent SBTx (9 isolated, 4 combined with liver Tx) at a median age of 3.5 years. Follow-up after SBTx was 0.4 to 14 years. Patient survival rates were 63% without SBTx and 77% with SBTx. After SBTx, 4 children experienced catch-up growth. Conclusions: PN in MVID is difficult to manage and requires expertise. Despite improved results in expert centers, the risk of death or irreversible sequelae is higher with PN than after Tx. SBTx, despite being complicated, remains the only hope to improve the quality of life and long-term prognosis of these children.

Microvillous inclusion disease: how to improve the prognosis of a severe congenital enterocyte disorder.

Assessment and outcome of children with intestinal failure referred for intestinal transplantation.

Objective: Small bowel (SB) transplantation (Tx), long considered a rescue therapy for patients with intestinal failure, is now a well recognised alternative treatment strategy to parental nutrition (PN). In this retrospective study, we analysed graft functions in 31 children after SBTx with a follow-up of 2–18 years (median 7 years). Patients: Twelve children had isolated SBTx, 19 had combined liver–SBTx and 17 received an additional colon graft. Growth, nutritional markers, stool balance studies, endoscopy and graft histology were recorded every 2–3 years post-Tx. Results: All children were weaned from PN after Tx and 26 children remained PN-free. Enteral nutrition was required for 14/31 (45%) patients at 2 years post-Tx. All children had high dietary energy intakes. The degree of steatorrhoea was fairly constant, with fat and energy absorption rates of 84–89%. Growth parameters revealed at transplantation a mean height Z-score of –1.17. After Tx, two-thirds of children had normal growth, whereas in one-third, Z-scores remained lower than –2, concomitant to a delayed puberty. Adult height was normal in 5/6. Endoscopy and histology analyses were normal in asymptomatic patients. Chronic rejection occurred only in non-compliant patients. Five intestinal grafts were removed 2.5–8 years post-Tx for acute or chronic rejection. Conclusions: This series indicates that long-term intestinal autonomy for up to 18 years is possible in the majority of patients after SBTx. Subnormal energy absorption and moderate steatorrhoea were often compensated for by hyperphagia, allowing normal growth and attainment of adult height. Long-term compliance is an important pre-requisite for long-term graft function.

https://gut.bmj.com/content/gutjnl/57/4/455.full.pdf

Long-term outcome, growth and digestive function in children 2 to 18 years after intestinal transplantation

The semen of domestic mammals is conventionally collected with an artificial vagina (AV) for artificial insemination (AI) or for short- or long-term storage. However, the procedure has certain drawbacks: animal training is not feasible in extensive animal care systems nor among wild species, as the trained animals sometimes fail to mount. Hence, there is a need for alternative semen collection methods. Electroejaculation (EEJ) and epididymal sperm recovery (ESR) are the two effective alternatives to AV. However, in recent years, animal welfare campaigners have called for the ban, in certain EU countries, of EEJ due to its inhumane nature. In this review, alternative methods of sperm collection (by EEJ and ESR, their qualities, and their freezing techniques) are highlighted, as well as the effects of EEJ on pre-freeze and post-thaw ram sperm quality parameters and the animal welfare progress made in EEJ between the 20th and 21st centuries. Additionally, the techniques for enhancing post-thaw sperm quality prior to freezing and for the freezing of EEJ and ESR spermatozoa are explored. ESR and EEJ are reliable alternatives to AV on certain occasions. EEJ is ideal for semen collection in wild or untrained animals, breeding soundness examinations, collection outside of the breeding season, and culling. At the same time, ESR is ideal in cases of castration, accidental death of elite sire, or postmortem for gene conservation purposes or assisted reproductive technologies (ARTs) studies.

/pdf/alternative-opportunities-to-collect-semen-and-sperm-cells-1s1h6a8m.pdf

Alternative Opportunities to Collect Semen and Sperm Cells for Ex Situ In Vitro Gene Conservation in Sheep

Gastrointestinal parasitism in ruminant animals is a cause of major economic loss incurred by the livestock industry. Regardless of the frequency of the adopted therapeutic and prophylactic deworming strategies, the parasitic burden in a farm should be assessed regularly. One of the most widely used techniques to do so is the microscopic faecal egg examination and faecal egg counting method. Despite the technique being almost a century old from its first adoption, the principle behind the newer techniques of faecal egg examination is the same. This technique is still being used in routine farm screening and monitoring gastrointestinal parasitic load and faecal egg count reduction testing to assess the anthelmintic efficacy of the drugs used. Thus, the tool remains a choice for preliminary screening for important parasites and the subsequent deworming strategy. Our study here was part of a larger survey on the treatment efficiency as well as a broad epidemiological study of the trichostrongyle parasites in Hungary. We present a preliminary report on the detection of common gastrointestinal parasites from two farms in Hungary, including a species-specific confirmatory microscopy for Haemonchus contortus eggs.

/pdf/routine-microscopy-examination-of-faecal-samples-as-a-tool-3inf22fl.pdf

Routine microscopy examination of faecal samples as a tool for detection of common gastrointestinal parasites: a preliminary report from two Hungarian farms

Gastrointestinal parasites are ubiquitous. They occur both in wild and domesticated animals. Among such parasites of veterinary importance is the trichostrongyle worms, out of which the Haemonchus contortus species is regarded as the most pathogenic one in the small ruminant industry. The occurrence of this parasite in the sheep flock is now very well documented and an established fact in Europe, although the parasite was original of the warmer climatic region. Studies on the cross-transmission of H. contortus between the wild and domesticated animals are also on the rise although the question of the direction of transmission is still debated. This is an important area that needs to be addressed as it could potentially contribute indirectly to mitigating anthelmintic resistance. Hungary also has reported its share of the occurrence of the parasite, mainly in the sheep flock and a certain population of roe deer. The study presented here is the preliminary results of a diagnostic case study that confirms the presence of H. contortus in wild ruminant deer species that are close to the domesticated sheep population.

/pdf/recovery-and-confirmation-of-haemonchus-contortus-from-2yuota5u.pdf

Recovery and confirmation of Haemonchus contortus from abomasal contents of roe deer (Capreolus capreolus) in Eastern-Hungary (Biharugra): A diagnostic case study

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Papers

Long-term outcome, growth and digestive function in children 2 to 18 years after intestinal transplantation

Alternative Opportunities to Collect Semen and Sperm Cells for Ex Situ In Vitro Gene Conservation in Sheep

Routine microscopy examination of faecal samples as a tool for detection of common gastrointestinal parasites: a preliminary report from two Hungarian farms

Recovery and confirmation of Haemonchus contortus from abomasal contents of roe deer (Capreolus capreolus) in Eastern-Hungary (Biharugra): A diagnostic case study