Intestinal transplantation: current outcomes and opportunities.
OBJECTIVE
This review highlights current outcomes in intestinal transplantation and summarizes advances that have recently occurred in five interrelated areas: progress in intestinal rehabilitation, immunologic and technical modifications, awareness of opportunities for improved allograft monitoring, and better assessment of long-term complications and morbidities.


RESULTS
Improved long-term management of patients with intestinal failure as well as improved outcomes with intestine transplant are changing the previously established paradigms of timing for referral. For those requiring transplant, use of monoclonal and polyclonal antibody induction protocols have been associated with improved outcomes. Experience at centers of excellence demonstrates 1 and 5 year patient survival rates of 93 and 78%, respectively with ongoing investigations focusing on lowering long-term causes of graft loss such as chronic rejection or morbidities such as renal dysfunction. Descriptions of tissue, proteomic and genomic technologies to complement traditional methodologies to monitor graft function are emerging.


CONCLUSIONS
Optimal timing for referral of children with intestinal failure and improved medical and surgical therapies increase the opportunity for intestinal adaptation without the need for transplant. For those undergoing transplant, technical and immunologic modifications, developments in graft monitoring, and reduction of long-term morbidities are leading to improved outcomes.
Mazariegos
George V
GV
Children's Hospital of Pittsburgh, Hillman Center for Pediatric Transplantation, Thomas E. Starzl Transplantation Institute, Pittsburgh, Pennsylvania, USA. george.mazariegos@chp.edu
D046148:Donor Selection; D006801:Humans; D007410:Intestinal Diseases / Q000601:surgery*; D007422:Intestines / Q000637:transplantation*; D016377:Organ Transplantation / Q000379:methods*; D016896:Treatment Outcome; D014850:Waiting Lists