Clinical aspects of small-bowel transplantation

Aim: To update clinical aspects of small-bowel transplantation. Methods: Cr itical review of the literature. Results: The two major functions of the sm all bowel are absorption of food and protection of the body against ingeste d pathogens. The highly developed immune system of the bowel. necessary for the latter function, prevented successful small-bowel transplantation duri ng the 1960s and 1970s by provoking early and severe rejection of the graft . The introduction of cyclosporin in the 1980s enabled small-bowel transpla ntation with a moderate success rate. Further improvement of immunosuppress ive regimens, especially the introduction of tacrolimus and aggressive surv eillance for and treatment of infections, has resulted in a slow but steady improvement of transplant results during the past decade. At this moment, however, long-term parenteral nutrition is still the first-line treatment o f the short-bowel syndrome worldwide because of the excellent results with regard to patient survival. Conclusion: Although results of small-bowel tra nsplantation are steadily improving, especially due to better immunosuppres sive regimens, long-term parenteral nutrition is still the first-line treat ment of short-bowel syndrome.