[Current status of pediatric intestinal transplantation]

While heart, liver, and kidney transplantation advanced rapidly as standard therapy for end-stage organ failure in the 1980s, intestinal transplantation was first recognized as a therapeutic option for intestinal failure in the 1990s. The development of intestinal transplantation was delayed because of difficulty in controlling rejection. In addition, infectious complications easily developed and became a cause of mortality and morbidity since the intestine is in contact with the outer environment, which contains numerous microorganisms. With better postoperative management and immunosuppressive regimens, the outcome of intestinal transplantation improved significantly. Although the progress in intestinal transplantation was due to the advent of tacrolimus, tacrolimus alone is not sufficient to suppress rejection in intestinal transplantation. New immunosuppressive regimens have been attempted, including cyclophosphomide, daclizumab, rATG (thymoglobulin) and alemtuzumab; bone marrow transplantation along with intestinal transplantation; and irradiation of the graft intestine. To date, however, no consensus has been reached even between the two major intestinal transplantation centers, the University of Pittsburgh and University of Miami, on the ultimate immunosuppressive regimens for intestinal transplantation (rATG vs. daclizumab). The same lack of consensus is seen for the indications for graft type (liver-intestine vs. multivisceral graft). For the success of intestinal transplant programs in Japan, it is mandatory to select and refine the strategy based on a precise analysis of the experiences from those large centers.