[Small bowel transplantation - current status and initial results].
During the last years, clinical small bowel transplantation has significantly improved. This is especially true for isolated small bowel transplantation with success rates of 80 % 1-year patient survival. Currently, approximately 100 small bowel transplantations are performed per year worldwide. In Germany, small bowel transplantation is still rare, because of the high risk for the development of acute rejection and rejection-associated complications. This includes peritonitis and sepsis as well as over-immunosuppression-associated infections. Due to improvements in immunosuppression, the incidence of acute rejection decreased from about 85 % below 25 %. Half of the patients will receive a combined liver-small bowel graft due to TPN (total parenteral nutrition)-associated liver cirrhosis. Although the combined procedure has immunological advantages, complication rates are high and patient survival is significantly lower (ca. 50 % at 1 year). Next to bacterial, fungal, and atypic infections, which are frequently associated with rejection and other complications, CMV and EBV infections are of significant interest. This is of special importance for EBV infections, since all PTLD (lymphoproliferative disease) after small bowel transplantation are EBV-associated so far. Viral infections should be monitored and preemptive therapy using ganciclovir or foscavir will be initiated. Of the 800 patients transplanted so far, 50 % are still alive up to 15 years. Of these, more than 80 % are off parenteral nutrition, in good healths, with good quality of live.
Müller
A R
AR
Klinik für Allgemeine- und Thoraxchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel. amueller@chirurgie-sh.de
Pascher
A
A
Platz
K-P
KP
Neuhaus
P
P
D000328:Adult; D020031:Epstein-Barr Virus Infections / Q000209:etiology; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy; D007421:Intestine, Small / Q000637:transplantation*; D016031:Liver Transplantation; D018810:Magnetic Resonance Angiography; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications; D011788:Quality of Life; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome