title: Intestinal and multivisceral transplantation.
abstract: Intestinal transplantation has shown exceptional growth over the past 10 years. At the end of the 1990's, intestinal transplantation moved out of the experimental realm to become a routine practice in treating patients with severe complications related to total parenteral nutrition and intestinal failure. In the last years, several centers reported an increasing improvement in survival outcomes (about 80%), during the first 12 months after surgery, but long-term survival is still a challenge. Several advances led to clinical application of transplants. Immunosuppression involved in intestinal and multivisceral transplantation was the biggest gain for this procedure in the past decade due to tacrolimus, and new inducing drugs, mono- and polyclonal anti-lymphocyte antibodies. Despite the advancement of rigid immunosuppression protocols, rejection is still very frequent in the first 12 months, and can result in long-term graft loss. The future of intestinal transplantation and multivisceral transplantation appears promising. The major challenge is early recognition of acute rejection in order to prevent graft loss, opportunistic infections associated to complications, post-transplant lymphoproliferative disease and graft versus host disease; and consequently, improve results in the long run.
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Sérgio Paiva
authors.initials: SP
authors.lastname: Meira Filho
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Bianca Della
authors.initials: BD
authors.lastname: Guardia
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Andréia Silva
authors.initials: AS
authors.lastname: Evangelista
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Celso Eduardo Lourenço
authors.initials: CE
authors.lastname: Matielo
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Douglas Bastos
authors.initials: DB
authors.lastname: Neves
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Fernando Luis
authors.initials: FL
authors.lastname: Pandullo
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Guilherme Eduardo Gonçalves
authors.initials: GE
authors.lastname: Felga
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Jefferson André da Silva
authors.initials: JA
authors.lastname: Alves
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Lilian Amorim
authors.initials: LA
authors.lastname: Curvelo
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Luiz Gustavo Guedes
authors.initials: LG
authors.lastname: Diaz
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Marcela Balbo
authors.initials: MB
authors.lastname: Rusi
authors.affiliation: Hospital Santa Marcelina, São Paulo, SP, Brazil.
authors.forename: Marcelo de Melo
authors.initials: Mde M
authors.lastname: Viveiros
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Marcio Dias de
authors.initials: MD
authors.lastname: Almeida
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Marina Gabrielle
authors.initials: MG
authors.lastname: Epstein
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Pamella Tung
authors.initials: PT
authors.lastname: Pedroso
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Paolo
authors.initials: P
authors.lastname: Salvalaggio
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Roberto Ferreira
authors.initials: RF
authors.lastname: Meirelles Júnior
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Rodrigo Andrey
authors.initials: RA
authors.lastname: Rocco
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Samira Scalso de
authors.initials: SS
authors.lastname: Almeida
authors.affiliation: Hospital Santa Marcelina, São Paulo, SP, Brazil.
authors.forename: Marcelo Bruno de
authors.initials: MB
authors.lastname: Rezende
mesh_terms: D006085:Graft Survival; D006801:Humans; D007422:Intestines / Q000637:transplantation*; D016031:Liver Transplantation; D016377:Organ Transplantation / Q000639:trends*; D014781:Viscera / Q000637:transplantation*