SMALL-BOWEL TRANSPLANTATION - AN OVERVIEW

Small bowel transplantation (SBT) would, in theory, be the treatment o f choice for patients suffering from the short bowel syndrome. Althoug h SBT has been done with a considerable degree of success in some cent ers [36, 145],it is by no means an established or widely applicable th erapy for those with short bowel syndrome. The small bowel is unique a mong vascularized organ grafts because it not only elicits a vigorous rejection reaction but is also capable of inducing graft-versus-host d isease (GVHD). Rejection of the graft does not only lead to loss of fu nction but also to bacterial translocation. The risk of fatal sepsis i s aggravated by the immunosuppression given to prevent rejection. Here , the history of SBT is described, and recent developments in experime ntal and clinical SBT, as well as future prospects for this theoretica lly optimal treatment modality for patients dependent on total parente ral nutrition (TPN) for life, are outlined.