Intestinal and multivisceral transplantation at Indiana University: 6 years' experience with 100 cases

Intestinal transplantation has shown exceptional growth over the past 20 years with extraordinary progress. As with other solid organ transplants, intestinal transplantation has now transitioned from being experimental to being the standard of care for patients with intestinal failure. The currently reported 1-year graft and patient survival rate is 80%, which approaches that for other solid abdominal organs. Unfortunately, most of the gains in survival are seen in the first postoperative year, with long-term survival remaining basically unchanged since the early 1990s. Immunosuppressive regimens continue to evolve, with induction therapy being the major change in the past 10 years. No randomized trials compare intestinal transplantation to long-term PN to establish guidelines for timely referral for this treatment option, so late referral remains a crippling problem in the field of intestinal transplantation. Patients referred late often develop severe liver dysfunction and fibrosis, resulting in a great number of patients in need of simultaneous liver transplantation at the time of listing for intestinal transplantation.