Others

Intestine

Intestinal transplantation alone, or in conjunction with other organs as a multivisceral graft, is considered to be the standard treatment for patients with intestinal failure. (Middleton et al., 2014) Small bowel transplantation is the most effective treatment in the management of paediatric short bowel syndrome (Zavras et al., 2015).

Analysis of 852 paediatric cases who received an intestinal transplant showed that 69% also received a simultaneous liver transplant. The more common underlying diagnoses in this series of patients were:

  • gastroschisis (24%)
  • necrotising enterocolitis (15%)
  • volvulus (14%)
  • other causes of short-gut syndrome (19%)
  • functional bowel syndrome (16%)
  • Hirschsprung disease (7%) (Lao et al., 2010).

The most common indications for intestinal transplantation in the US during 2015 were:

  • short gut syndrome (other) (51.4%)
  • congenital short gut syndrome (10.0%)
  • pseudo-obstruction (8.6%) (Smith et al., 2017).

Cornea

Procedures for corneal transplantation or keratoplasty comprise whole organ transplant - penetrating keratoplasty; or lamellar transplantation surgery in which only the diseased layers of the cornea are replaced (Tan, 2012; Kymionis et al., 2014).

Indications for penetrating keratoplasty include failed graft, bullous keratopathy, keratoconus, corneal scar, corneal perforation from infection, and Fuchs’ endothelial dystrophy, with failed graft being the most common indication for transplantation (29%) in a retrospective analysis of one series of patients (Randleman et al., 2003).

Indications for corneal endothelial transplantation or endothelial keratoplasty are the genetic disorder Fuchs' endothelial dystrophy; the degenerative disorder, bullous keratopathy; trauma, infection and iatrogenic damage (National Institute for Health and Care Excellence (NICE), 2009).

The most common indications for corneal transplantation in the US for 2012 were:

  • keratoconus (20%)
  • repeat corneal transplant (12%)
  • post-cataract surgery oedema (10%) (Milliman, 2014).

Limbal stem cell transplantation was developed to correct the deficiency of patients with limbal stem cell deficiency who suffer from a severe loss of vision and photophobia. Donor sources for transplantation are autologous or living-related allogeneic for conjunctival-limbal transplantation; and allogeneic for keratolimbal transplantation (Health Quality Ontario, 2008; Liang et al., 2009).

Haematopoietic stem-cell transplant (HSCT)

Haematopoietic stem-cell transplantation (HSCT) is used primarily to treat haematological and lymphoid cancers. The majority of autologous transplantations performed worldwide (around two thirds), are used to treat multiple myeloma or non-Hodgkin’s lymphoma; whereas treatment of acute leukaemia accounts for nearly half of all allogeneic transplantations performed worldwide (Copelan, 2006).

Autologous HSCT is also used to treat non-malignant diseases such as autoimmune disorders or amyloidosis. Conditions which are treated with allogeneic HSCT include: aplastic, Fanconi’s and sickle cell anaemias, thalassaemia major, severe combined immunodeficiency, Wiskott–Aldrich syndrome and inborn errors of metabolism (Copelan, 2006).

In Europe the main indications for HSCT in 2014 were lymphoid neoplasias (n=20,802; 57%; 11% allogeneic); leukaemias (n=11,853; 33%; 96% allogeneic); solid tumours (n=1458; 4%; 3% allogeneic) and non-malignant disorders (n=2203; 6%; 88% allogeneic) (Passweg et al., 2016).

In the US for 2010 the most common indications for autologous HSCTs were:

  • multiple myeloma (55%)
  • non-Hodgkin's lymphoma (25%)
  • Hodgkin's disease (9%).

For allogeneic HSCTs, the most common indications were:

  • acute myeloid leukaemia (AML) (35%)
  • acute lymphoblastic leukaemia (ALL) (15%)
  • myelodysplastic syndrome (MDS)/myeloproliferative disease (13%) (Milliman, 2014).