Small bowel and multivisceral transplantations

Small intestine transplantation is an evolving surgical procedure used in the management of intestinal failure in children and adults. Their outcomes have dramatically improved in recent years, with overall patient survival in both children and adults at 1 year reaching approximately 70-80%. The world registry collected just under 1000 cases as of 2003, and approximately 120 cases are added to the registry each year. Acute rejection of the small bowel remained the most disturbing problem in the treatment of patients undergoing these procedures. Substantial progress has been made recently in improving patient and graft survival rates after these procedures; this progress is largely the result of improvement in techniques for monitoring rejection and of new strategies for immunosuppression. This article summarizes recent advances in this field of transplantation, including selection of the graft, immunosuppression strategies, and methods of monitoring rejection. It also provides an algorithm of patient referral to transplant centers.