Small Bowel Transplantation: the New Frontier in Organ Transplantation
The last ten years have witnessed the emergence of small bowel transplantation (SBT) as a viable treatment modality for selected patients with intestinal failure. The introduction of effective immunosuppressive medications was the most important factor in allowing transplantation of this “forbidden organ”. The technical aspects of harvesting and transplanting the intestine were studied early in the century by Alexis Carrel and later refined by Lillehei and colleagues  at the University of Minnesota in 1955. Monchick and Russell  established a rat model for SBT which opened the door for investigators to explore unidirectional immune phenomena as well as physiologic function of the transplanted gut. All seven attempts at SBT in humans that were made prior to the introduction of cyclosporine failed because grafts were lost to early rejection or sepsis. Experience with SBT under cyclosporine immunosuppression was encouraging, but ultimately proved to be unsatisfactory as graft loss to rejection continued to be inevitable. Success in human SBT hinged on the advent of FK506 (tacrolimus), which has shown to be of great promise in liver and experimental SBT.
KeywordsFermentation Glutamine Folic Acid Leucine Vasculitis
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