[Small intestine transplantation].
BACKGROUND
Significant progress has been made in clinical small bowel transplantation over the last decade mainly due advances in biotechnology and new immunosuppressive regiments. This transplantation has now been indicated to treat special cases of intestinal failure.


OBJECTIVE
This review highlights recent developments in the area of small bowel transplantation.


METHODS
Over 600 reports on clinical and experimental small bowel transplantation were reviewed. Aspects concerning research development, different immunosuppressive strategies, patient and graft monitoring, and improvements in surgical techniques are discussed.


RESULTS
About 700 small bowel transplantation were performed in 55 transplant centers, 44% intestine-liver, 41% isolated intestinal graft and 15% multivisceral transplantation. Rejection and infection are the main limitation of this procedure. Actual 5 years post transplantation graft survival of the total international experience is 46% for isolated intestinal graft, 43% for combined intestine-liver and nearly 30% for multivisceral transplantation. Higher graft and patient survival are seen at the more experienced centers. In a series of 165 intestinal transplantation at University of Pittsburgh, PA, USA, actuarial patient survival was reported to be over 75% at one year, 54% at 5 years and 42% at 10 years. Over 90% patients from Pittsburgh program resume an unrestricted oral diet.


CONCLUSIONS
Small bowel transplantation has advanced from an experimental strategy to a feasible alternative for patients with permanent intestinal failure. Further refinements in graft acceptance, immunosuppressive regiments, infection management and prophylaxis, surgical techniques as well as appropriated patient referral and selection are crucial to improve outcomes.
Galvão
Flávio Henrique Ferreira
FH
Disciplina de Cirurgia do Aparelho Digestivo da Faculdade de Medicina, Universidade de São Paulo, SP, Brazil. fgalvao@usp.br
Waitzberg
Dan Linetzky
DL
Bacchella
Telesforo
T
Gama-Rodrigues
Joaquim
J
Machado
Marcel Cerqueira Cesar
MC
D005500:Follow-Up Studies; D006801:Humans; D007421:Intestine, Small / Q000637:transplantation*; D008991:Monitoring, Physiologic; D023001:Transplantation Tolerance