A detailed analysis of the current status of intestinal transplantation in the Middle East
Hamed Nikoupour1, Peyman Arasteh1, Saman Nikeghbalian1.
1Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran (Islamic Republic of)
Introduction: Intestinal transplantations (IT) are among the most complex transplantations which are performed in few centers in the world. When patients develop intestinal failure, different treatment modalities including parenteral nutrition, autologous gastrointestinal tract reconstructive surgery and IT are considered. The Middle East is a region where reports on intestinal failures and IT are mainly lacking.
Materials and Methods: In the present review, we highlighted the status of IT in the Middle East and focused on existing reports from this region.
Results: From 2006 onward, the Shiraz Transplant Center has been the only center in Iran to perform this type of transplantation. So far, a total of 49 ITs have been performed in the center, among which 18 transplantations have been isolated ITs, 19 combined liver-intestine transplantations, 12 multi-visceral transplantations, and a total of 6 have been in the settings of modified multi-visceral transplantations. Two studies have been published in Turkey during the past ten years in which authors have reported on 9 patients who had ITs. All patient in Turkey had isolated IT. In the two reports authors found that the main etiology for IT in their center was Waardenburg syndrome (n = 4), malrotation (n = 2), trauma (n = 1), graft loss (n = 1) and megacystis microcolon intestinal hypoperistalsis (n = 1). Reports from Israel have been scarce. The first adult IT in Israel was performed in 2014 in the Beilinson Hospital, in Petah Tikva, Israel.
Discussion: Very few countries in the Middle East have the facilities for home parenteral nutrition and only two countries of Iran and Turkey perform ITs in the region. With advances in intestinal rehabilitation units and development of autologous gastrointestinal tract reconstructive surgery some centers have been able to reduce the number of patients in need of ITs.
Conclusion: An overview of the condition of ITs in the Middle East shows that the issue of intestinal failure and the treatment facilities still remain an unsolved problem. Although there exists a high need for IT, advances in reconstructive surgeries and the development of parenteral nutrition in this region, can significantly reduce the need for ITs among patients with intestinal failure.
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