Intestinal Transplantation: UK perspective & NASIT
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St Mark's IF with AuSPEN 30 - 31 October 2015
![NASIT: National Adult Intestinal
Transplantation Forum
Founded in 2005
by Cambridge [SJ Middleton] & St Mark’s [SM Gabe]
Cambridge, Oxford, St Mark’s, Salford Royal
Open invitation to all centres
Convenes 2 monthly
All potential transplants are presented
Multidisciplinary
NHS England HSC and NHS B&T requirement
Recently combined with the (Manchester) bowel
lengthening programme (AuGIR)](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
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Intestinal Transplantation: UK perspective & NASIT
- 1. Intestinal transplantation UK perspective & NASIT Dr Simon Gabe St Mark’s Hospital
- 2. NASIT: National Adult Intestinal Transplantation Forum Founded in 2005 by Cambridge [SJ Middleton] & St Mark’s [SM Gabe] Cambridge, Oxford, St Mark’s, Salford Royal Open invitation to all centres Convenes 2 monthly All potential transplants are presented Multidisciplinary NHS England HSC and NHS B&T requirement Recently combined with the (Manchester) bowel lengthening programme (AuGIR)
- 3. Intestinal transplantation Indications Irreversible IF, and Liver disease Fibrotic liver disease Severe sepsis Life threatening (>1) Loss of venous access Limited to 3 major sites Poor QOL Correctable by transplantation Partial or complete evisceration Evisceration requiring MVTx (eg desmoid) Need for other abdominal organ transplant eg kidney
- 4. Intestinal transplantation Indications Refer / discuss Irreversible IF, and Liver disease Fibrotic liver disease Progressive IFALD Severe sepsis Life threatening (>1) Life threatening (1) Loss of venous access Limited to 3 major sites Limited to 4 major sites Poor QOL Correctable by transplantation Correctable by transplantation Partial or complete evisceration Evisceration requiring MVTx (eg desmoid) Strategies to minimise surgical resection Need for other abdominal organ transplant eg kidney eg kidney
- 5. ITx: numbers over time Grant et al, Am J Transplant 2015;15:210–219
- 6. Intestinal Transplant Registry Report © 2013 0 50 100 150 200 250 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 NumberofTransplants Year of Transplant Children Adults Intestinal Transplants Performed
- 7. Types of ITx over time Grant et al, Am J Transplant 2015;15:210–219
- 8. Graft survival over time Grant et al, Am J Transplant 2015;15:210–219
- 9. Adult survival by transplant type
- 10. Current UK centres for small bowel transplantation Year started No. transplants Adult Cambridge 1991 53 Oxford 2008 22 Paediatric Birmingham 1993 94 KCH, London 2009 15
- 11. UK adult ITx: 2005-2015 Centre Intestinal transplant type N 1 year survival (95% CI) 5 year survival (95% CI) Cambridge Including liver 26 68 (46-82) 26 (6-55) Not including liver 21 89 (63-99) 78 (42-92) Oxford Not including liver 28 78 (57-90) 62 (38-80) Total 75 78 (65-86) 52 (34-67)
- 12. UK paediatric ITx: 2005-2015 Centre Intestinal transplant type N 1 year survival (95% CI) 5 year survival (95% CI) Birmingham Including liver 28 78 (59-90) 52 (32-69) Not including liver 19 90 (65-97) 73 (40-90) Kings All types 14 90 (48-99) 90 (48-99) Total 61 85 (71-92) 66 (50-78)
- 13. Nutrition after intestinal transplantation Cambridge 0% 20% 40% 60% 80% 100% Adults Children Full Function IV Fluids No Function International registry
- 14. Nutrition after intestinal transplantation Cambridge 0% 20% 40% 60% 80% 100% Adults Children Full Function IV Fluids No Function No function International registry
- 15. Intestinal transplantation Indications Refer / discuss Irreversible IF, and Liver disease Fibrotic liver disease Progressive IFALD Severe sepsis Life threatening (>1) Life threatening (1) Loss of venous access Limited to 3 major sites Limited to 4 major sites Poor QOL Correctable by transplantation Correctable by transplantation Partial or complete evisceration Evisceration requiring MVTx (eg desmoid) Strategies to minimise surgical resection Need for other abdominal organ transplant eg kidney eg kidney
Editor's Notes
- Slide of world case numbers Over the last 20 yrs the numbers of SBT steadily increased to peak in 2008 but since this time cases have fallen considerably to reach an all time low for the last decade at around 100 in 2012 of which about 50 were in children and similar to the situation at the turn of the millennium. The reason for this remains uncertain but may be consequence of a more conservative approach to the use of the technique due to less than satisfactory survival figures reported by the international registry
- It is our experience that About 3/4 of surviving patients end up eating normally and the other ¼ are divided between enteral and pn nutritional support
- It is our experience that About 3/4 of surviving patients end up eating normally and the other ¼ are divided between enteral and pn nutritional support