Clinical aspects of small-bowel transplantation

To update clinical aspects of small-bowel transplantation.

Critical review of the literature.

The two major functions of the small bowel are absorption of food and protection of the body against ingested pathogens. The highly developed immune system of the bowel, necessary for the latter function, prevented successful small-bowel transplantation during the 1960s and 1970s by provoking early and severe rejection of the graft. The introduction of cyclosporin in the 1980s enabled small-bowel transplantation with a moderate success rate. Further improvement of immunosuppressive regimens, especially the introduction of tacrolimus and aggressive surveillance 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 of the short-bowel syndrome world-wide because of the excellent results with regard to patient survival.

Although results of small-bowel transplantation are steadily improving, especially due to better immunosuppressive regimens, long-term parenteral nutrition is still the first-line treatment of short-bowel syndrome.