Can intestinal transplantation constitute treatment for intestinal failure?

The management of patients with intestinal failure has benefited from progr ess in parenteral nutrition (PN), especially home-based parental nutrition. Intestinal transplantation is now possible and in some conditions, constit utes the logical treatment option. Since 1985, more than 300 small-bowel gr afts have been performed, involving the isolated small bowel with or withou t the colon (45 %), the liver + small bowel (40 %) or several organs (15 %) . 2/ of recipients were under 20 yeats of age, and indications were short-b owel syndrome (64 %), severe intractable diarrhea (13 %), abdominal cancer (13 %), or chronic intestinal pseudo-obstruction syndrome (8 %). 51 % of pa tients survived > 2 years after the graft. Patient and graft survival depen ds on the type of immunosuppression, i.e. Ciclosporine or FK 506. The resul ts must be interpreted carefully as they represent the first experience in numerous centers using different immunosuppressive protocols, without any r andomization. The results from the largest of these centers more closely re flect the current situation and may exceed a 70 % 2-year survival rate. Fun ctional grafts lead to gastrointestinal autonomy (weaning of PN) while main taining satisfactory nutritional status and normal growth in childhood. Int estinal transplantation is theoretically indicated for all patients permane ntly or persistently dependent on PN. However, as PN is generally well tole rated, even for long periods, each indication for transplantation must be c arefully weighed up in terms of the iatrogenic risk and quality of life. Wh en PN has reached its limits, especially those associated with vascular, in fectious, hepatic or metabolic complications, intestinal transplantation mu st be undertaken. Transplantation of the small bowel alone remains the firs t option, as combined liver-small bowel grafting is only indicated in case of life-threatening progressive cirrhogenic liver disease.