Intestinal transplantation

Intestinal failure continues to be a major health problem for both adults and children. Most patients with intestinal failure can be rehabilitated so that they can tolerate enteral nutrition, but for those that cannot, intestinal transplantation has emerged as a life saving therapy. It is now a routine therapeutic tool at some transplant centers. The short- and long-term survival rates after intestinal transplantation have steadily improved. The complications associated with intestinal transplantation continue to be perforations, infections and rejection. The technical aspects of the operation have been refined and standardized. New immunosuppressive agents have decreased the graft loss rate from overwhelming rejection. Experience in treating these very ill patients has reduced complications and improved survival This review focuses on patient selection, the surgical techniques for both isolated small bowel and combined liver/small bowel transplantation, post-operative management, and the results that have been achieved to date.