Intestinal and multivisceral transplantation: future perspectives

Area of Science:

• Gastroenterology
• Surgical Innovation
• Transplant Medicine

Background:

• Intestinal transplantation has seen significant advancements in patient and graft survival.
• This progress has led to an increase in the number of intestinal transplant programs worldwide.
• Indications for intestinal transplant are diverse, including irreversible intestinal failure with complications like liver failure or recurrent infections.

Purpose of the Study:

• To review the current status and future directions of intestinal transplantation.
• To highlight the individualized approach to graft selection based on patient diagnosis.
• To discuss current immunosuppression protocols and challenges in managing intestinal grafts.

Main Methods:

• Review of current literature and clinical practices in intestinal transplantation.
• Analysis of indications, graft types, and surgical considerations.
• Examination of immunosuppression strategies, rejection, and infection management.

Main Results:

• Patient and graft survival rates in intestinal transplantation have progressively increased.
• Graft selection is tailored to patient conditions: isolated intestinal for short gut syndrome, liver-intestine/multivisceral for liver failure, and modified multivisceral for dysmotility.
• Tacrolimus-based immunosuppression is standard, but rejection and infections remain primary causes of morbidity and mortality.

Conclusions:

• Close monitoring of intestinal grafts is crucial to prevent rejection and infections.
• Future advancements include non-invasive rejection markers, refined surgical techniques, advanced immunosuppression, and expanded living-related and multivisceral transplantation.
• Continued research and development are vital for improving long-term outcomes in intestinal transplantation.