Recent advances and future prospects in intestinal and multi-visceral transplantation

From an experimental procedure, intestinal transplantation (ITx) has evolve d over the last 10 yr into a treatment option for patients suffering from s hort bowel syndrome and who develop life-threatening complications from tot al parenteral nutrition (TPN) (e.g. liver dysfunction, line sepsis, shortag e of venous access, etc.). One-year survival rates are approximate to 70% a nd thus similar to lung Tx. However, the intestine remains the most challen ging abdominal organ to transplant. This is because of the severe immune re sponse (mostly rejection) that is produced. and therefore the need for prof ound immunosuppression with its attendant complications (sepsis, lymphoma, direct drug toxicity). Unlike other organs, graft loss as a result of acute rejection can Occur late after transplantation (more than 1 yr post-transp lant). With regard to the actual immunosuppressive regimens, considerable e xperience in patient management is required to optimize outcome of those co mplex transplants. which are permanently at risk of rejection and infection . ITx remains an unfinished product, and the application of ITx to patients doing well on TPN warrants further research in the understanding of the re jection process, in the development of less toxic and more efficient immuno suppressive protocols. and in the development of immunomodulatory strategie s, to better control rejection and thereby reduce the need for immunosuppre ssion.