Abstract
Intestinal transplantation is now a valid therapeutic option for patients with chronic irreversible intestinal failure suffering life-threatening complications of home parenteral nutrition, which remains the first-line management option for these patients, due to its better long-term survival. For high-risk patients, “preemptive” intestinal transplantation alone should be discussed before home parenteral nutrition-related complications occur. The results in terms of patient survival have improved over the past 20 years: early graft survival is currently similar to other solid organ transplanted, but long-term survival rate still does not exceed 50 %. Even though surgical techniques for isolated intestine, liver-intestine, and multivisceral transplantation were developed in the 1960s, very few patients were transplanted before 1990, because of inadequate initial immunosuppressive regimens. The discouraging results of the first clinical trials were due to technical complications, sepsis, and the failure of conventional immunosuppression to control rejection. By 1990, the development of tacrolimus-based immunosuppression, as well as improved surgical techniques, the increased array of potent immunosuppressive medications, infection prophylaxis, and better patient selection helped to improve actuarial graft and patient survival rates for all types of intestine transplantation.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Alessiani M, Tzakis A, Todo S, Demetris AJ, Fung JJ, Starzl TE. Assessment of five-year experience with abdominal organ cluster transplantation. J Am Coll Surg. 1995;180(1):1–9.
Starzl TE, Todo S, Tzakis A, Alessiani M, Casavilla A, Abu-ElMagd K, Fung JJ. The many faces of multivisceral transplantation. Surg Gynecol Ostet. 1991;172(5):335–44.
Abu-Elmagd K. The small bowel contained allografts: existing and proposed nomenclature. Am J Transplant. 2011;11(1):184–5.
Abu-Elmagd KM, Costa G, Bond GJ, Soltys K, Sindhi R, Wu T, Koritsky DA, Schuster B, Martin L, Cruz RJ, Murase N, Zeevi A, Irish W, Ayyash MO, Matarese L, Humar A, Mazariegos G. Five hundred intestinal and multivisceral transplantations at a single center: major advances with new challenges. Ann Surg. 2009;250(4):567–81.
Tzakis AG, Todo S, Reyes J, Nour B, Fung JJ, Starzl TE. Piggyback orthotopic intestinal transplantation. Surg Gynecol Ostet. 1993;176(3):297–8.
Berney T, Kato T, Nishida S, Tector AJ, Mittal NK, Madariaga J, Nery JR, Cantwell GP, Ruiz P, Tzakis AG. Portal versus systemic drainage of small bowel allografts: comparative assessment of survival, function, rejection, and bacterial translocation. J Am Coll Surg. 2002;195(6):804–13.
Tzakis AG, Nour B, Reyes J, Abu-Elmagd K, Furukawa H, Todo S, Starzl TE. Endorectal pull-through of transplanted colon as part of intestinal transplantation. Surgery. 1995;117(4):451–3.
Reyes J, Mazariegos GV, Bond GM, Green M, Dvorchik I, Kosmach-Park B, Abu-Elmagd K. Pediatric intestinal transplantation: historical notes, principles and controversies. Pediatr Transplant. 2002;6(3):193–207.
Starzl T, Kauup Jr HA. Mass homotransplantations of abdominal organs in dogs. Surg Forum. 1960;11:28–30.
Starzl TE, Rowe MI, Todo S, Jaffe R, Tzakis A, Hoffman AL, Esquivel C, Porter KA, Venkataramanan R, Makowka L, et al. Transplantation of multiple abdominal viscera. JAMA. 1989;261(10):1449–57.
Nishida S, Vaidya A, Kato T, Nakamura N, Madariaga J, Tzakis A. Use of donor aorta for arterial reconstruction in paediatric liver and multivisceral transplantation. Br J Surg. 2004;91(6):705–8.
Girlanda R, Desai CS, Matsumoto CS, Kaufman SS, Little CA, Fishbein TM. Complex arterial reconstruction in multivisceral transplantation. Am J Transplant. 2010;10(3):698–701.
Tzakis AG, Kato T, Levi DM, Defaria W, Selvaggi G, Weppler D, Nishida S, Moon J, Madariaga JR, David AI, Gaynor JJ, Thompson J, Hernandez E, Martinez E, Cantwell GP, Augenstein JS, Gyamfi A, Pretto EA, Dowdy L, Tryphonopoulos P, Ruiz P. 100 multivisceral transplants at a single center. Ann Surg. 2005;242(4):480–90.
Matsumoto CS, Fishbein TM. Modified multivisceral transplantation with splenopancreatic preservation. Transplantation. 2007;83(2):234–6.
Cruz Jr RJ, Costa G, Bond GJ, Soltys K, Rubin E, Humar A, Abu-Elmagd KM. Modified multivisceral transplantation with spleen-preserving pancreaticoduodenectomy for patients with familial adenomatous polyposis Gardner’s Syndrome. Transplantation. 2011;91(12):1417–23.
Selvaggi G, Nishida S, Levi D, Moon J, Island E, Tekin A, Weppler D, Tzakis A. Intestinal and multivisceral transplantation at the University of Miami. Clin Transpl. 2009; 211–7.
Kato T, Ruiz P, Thompson JF, et al. Intestinal and multivisceral transplantation. World J Surg. 2002;26:226.
Bozzetti F, Staun M, Van Gossum A, editors. Home parenteral nutrition. Wallingford: CAB International; 2006.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Pinna, A.D., Zanfi, C. (2015). Intestinal/Multivisceral Transplantation. In: Pinna, A., Ercolani, G. (eds) Abdominal Solid Organ Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-319-16997-2_25
Download citation
DOI: https://doi.org/10.1007/978-3-319-16997-2_25
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-16996-5
Online ISBN: 978-3-319-16997-2
eBook Packages: MedicineMedicine (R0)