Intestinal Transplantation

Intestinal transplantation has become a therapeutic option for irreversible benign chronic intestinal failure associated with life-threatening complications of long-term HPN or high risk of death due to the underlying gastrointestinal disease. Four transplant types can be performed: isolated small bowel transplant, multivisceral transplant, combined liver-intestine transplant and liver-multivisceral transplant. The International Transplant Registry report shows overall patient survival rates of 65% at one year and 50% at 3 years, and graft survival of 60% at 1 year and 46% at 3 years. More than 80% of survivors stopped parenteral nutrition and resumed normal daily activities. Both patient and graft survival steadily improved over time. After 1998, in centers with more than 10-transplants experience, survival rate was 80% at 1 year and 62% at 3 years in isolated intestine recipients, 70% at 1 year and 65% at 3 years in multivisceral recipients and 60% at 1 year and 50% at 3 years in liver-intestine recipients. Recipient and donor selection is a landmark for good graft and patient survival and further improvement in survival is expected from a timely patient referral. The main complications encountered after intestinal transplantation are rejections, infections, re-laparotomies and post-transplant lymphoproliferative disease. Complications account for most of the post-trasplant patient deaths and graft failure.