[Intestinal transplantation in adults: present situation and future prospects].
Intestinal transplantation is becoming more firmly established as a treatment for intestinal failure in patients whose home parenteral nutrition regimens have caused serious side effects. Outcomes have improved spectacularly over recent years thanks to the refinement of surgical techniques and the introduction of new immunosuppressants, and also to greater experience in anesthetic and postoperative management of intestinal transplant patients. The main causes of high morbidity and mortality continue to be sepsis and acute rejection of the graft. Both graft and patient survival have improved with the advent of the immunosuppressant regimens based on Tacrolimus, although survival rates are still far below those reported for other solid organ transplants. The first intestinal transplant performed in Spain took place in July 2002 in our hospital and the results were promising. Given this new challenge for anesthesiologists, we decided to review current trends in the perioperative management of patients receiving isolated intestinal transplants, the main complications that arise, treatment strategies, and future prospects.
Gajate Martín
L
L
Servicio de Anestesiología y Reanimación, Unidad de Trasplantes, Hospital Ramón y Cajal, Madrid. luisgump@hotmail.com
Elías Martín
E
E
Martínez Pérez
A
A
Carrasco Seral
C
C
Alvarez Utrera
F
F
Pablo de Pajares
A
A
Pinto Corraliza
J
J
Honrubia Checa
A
A
Vicente de López
E
E
Quijano-Collazo
Y
Y
Bárcena Marugan
R
R
D011125:Adenomatous Polyposis Coli / Q000601:surgery; D000328:Adult; D000768:Anesthesia, General; D046148:Donor Selection; D005260:Female; D005544:Forecasting; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007422:Intestines / Q000637:transplantation*; D016343:Monitoring, Intraoperative; D010289:Parenteral Nutrition, Total; D011183:Postoperative Complications; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome