Intestinal transplantation: current status

Abstract

Current Treatment Of Intestinal Failure Consists Of Long-Term Total Parenteral Nutrition, Which Is Associated With Major Complications Including Liver Failure And Catheter Problems. The Ultimate Solution Is Small Bowel Transplantation. After Overcoming Technical Difficulties, The Major Obstacle To Clinical Success Of Intestinal Transplantation Is Immunological. Intestinal Transplantation Is Characterized By An Aggressive Rejection Which Is Difficult To Control With Immunosuppression. The Introduction Of Tacrolimus For Use In Intestinal Transplantation In 1990 Has Resulted In Major Improvements In Short-Term Survival; But Long-Term Outcome Remains Unsatisfactory: There Is A High Incidence Of Rejection (Ineffective Immunosuppression), And Opportunistic Infection And Post-Transplant Lymphoproliferative Disease (Over-Immunosuppression). Up To 1997, 260 Patients Have Received 273 Transplants In 33 Centers, With Roughly Similar Numbers Of Isolated Small Bowel Transplantation And Combined Small Bowel And Liver Transplantation. Data From The Largest Series Reveal Patient Survival Of 72% At One Year, 58% At Two Years, And 33% At Five Years With A Graft Survival Of 61%, 43%, And 26%, Respectively. At Present, Intestinal Transplantation Can Be Considered As A Life-Saving Option For Patients With Intestinal Failure Who Cannot Tolerate Total Parenteral Nutrition. Major Advances In The Basic Understanding Of The Unique Immune Mechanisms Involved In Intestinal Transplantation And The Discovery Of New And Specific Immunosuppression Will Be Necessary To Allow The Therapeutic Procedure Of Transplantation To Realize Its Full Potential In The Clinical Management Of Intestinal Failure.