Intestinal Transplantation

Summary

Intestinal transplantation has developed into an acceptable form of therapy for patients with life-threatening complications of intestinal failure. Intestinal failure is most commonly the result of loss of the gastrointestinal tract, which results in the short-bowel syndrome. The most common reason to consider patients for intestinal transplantation is when they have developed total parenteral nutrition-related liver disease. The type of transplant that the patient will receive is often dictated by the degree of underlying liver disease. Other indications for isolated intestinal transplantation include recurrent sepsis and loss of venous access. The surgical techniques for intestinal transplantation have been modified over the years. Patients are matched with donors based on blood type and size. Following transplantation, immune suppression is based on tacrolimus. Improvements in rejection episodes have been seen with the addition of interleukin-2-receptor blocking agents. Bowel biopsies are critical to making a diagnosis of rejection. Serious complications such as cytomegalovirus infections and lymphoproliferative disease are being managed with greater success. Chronic rejection remains a difficult long-term problem. The intestinal allograft can effectively provide nutritional autonomy to patients. As the results of intestinal transplantation continue to improve, more patients will be offered this form of therapy for treatment of their intestinal failure.