Intestinal and Multivisceral Transplantation Workup

Updated: Feb 22, 2021
  • Author: Richard K Gilroy, MD, FRACP; Chief Editor: Stuart M Greenstein, MD  more...
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Laboratory Studies

Perform a complete blood cell count to rule out anemia and thrombocytopenia. Assess electrolyte levels to look for electrolyte imbalance caused by short bowel syndrome. Perform the following liver function tests to rule out cholestatic liver failure and evaluate liver function:

  • Serum aspartate aminotransferase (AST)
  • Serum alanine aminotransferase (ALT)
  • Alkaline phosphatase (ALP)
  • Glucose tolerance test

Measure prothrombin time (PT) and activated partial thromboplastin time (aPTT) to rule out coagulation abnormalities and evaluate liver function. Measure the following to rule out deficiencies as the cause of thrombosis:

  • Protein C
  • Protein S
  • Clotting factors
  • Vitamins B12, K, and D

Perform urinalysis to evaluate renal function and rule out infection. Calculate creatinine clearance to evaluate renal function. Perform a culture to rule out infection. Assess vitamin levels to evaluate nutrition. Perform an absorption test to evaluate intestinal function.

Donor-specific antibodies (DSA) are evaluated to quantify the sensitization.

Citrulline levels are measured to monitor the condition of the intestine.

Additional tests that may be helpful include the following:

  • Total and direct bilirubin
  • Serum albumin
  • Phosphorus and magnesium
  • Cholesterol and triglycerides
  • Zinc and selenium
  • Free and total carnitine
  • Cytomegalovirus (CMV), Epstein-Barr virus (EBV), hepatitis B virus, hepatitis C virus, and human immunodeficiency virus
  • Alpha-fetoprotein
  • Cytotoxic antibody screen

Imaging Studies

Imaging studies include the following [39] :

  • Doppler ultrasonography of the extremities to assess the patency of the veins
  • Doppler ultrasonography of the liver to assess the patency of the vessels
  • Computed tomography scanning of the abdomen
  • Upper gastrointestinal (GI) series with small bowel follow-through
  • Angiography of the abdomen
  • Magnetic resonance imaging/magnetic resonance angiography
  • Echocardiography/stress echocardiography
  • Nuclear medicine studies

Other Tests

Other tests that may be performed include the following:

  • Electrocardiography
  • Motility studies (as indicated)
  • Liver biopsy (as indicated)
  • Upper gastrointestinal endoscopy

If intestinal failure is functional, the diagnosis depends on the pathological findings and exclusion of other etiologies. Biopsy of the intestine is necessary for the final diagnosis. Perform case-by-case evaluations.