Postoperative Management

At the University of Miami, immunosuppression traditionally included tacrolimus, corticosteroids, and mycophe-nolate mofetil (Kato et al, 2002). Twelve-hour tacrolimus trough levels are aimed at 15 to 20 ng/mL. The combination of tacrolimus with alemtuzumab (Campath-IH) without steroids has recently been found to be effective in preventing acute rejection without an increase in opportunistic infections (Tzakis et al, 2003).

Enteral infusion of 5% dextrose in water via a feeding tube can be started immediately after surgery. This is advanced rapidly as the ostomy becomes functional. Adequate function of the graft is monitored by ostomy output volume and the presence of reducing substances. High ostomy outputs require intravenous fluid replacement. Other variables that should be taken into account include delayed gastric emptying and the lack of training for oral intake of patients on long term TPN. Caloric needs may not be met by oral intake alone sometimes for up to 12 months.

Postoperative surveillance biopsies are usually performed in the immediate postoperative period. Furthermore, changes in intestinal function manifest by increased output, bloody output, mucosal sloughing, malabsorption, changes in mucosal appearance, warrant endoscopy and biopsy. In experienced hands, the allograft can also be evaluated by the presence of magnifying, high-resolution endoscopes (Kato et al, 2002).

Some centers perform infusion of bone marrow from the donor to induce tolerance by enhancing chimerism (Ricordi et al, 1997).

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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