Intestinal transplantation: indications and prospects

Area of Science:

• Gastroenterology and Hepatology
• Transplantation Surgery
• Immunology

Background:

• Intestinal transplantation (IT) is a complex procedure for intestinal failure, often combined with liver or multivisceral transplantation.
• Home parenteral nutrition (PN) remains the primary treatment for intestinal failure, with IT reserved for specific, severe cases.
• Current indications for IT are debated, highlighting the need for refined patient selection criteria.

Purpose of the Study:

• To review the current status and indications for intestinal transplantation.
• To analyze short-term and long-term survival outcomes of IT.
• To explore potential future developments to improve IT success rates.

Main Methods:

• Review of existing literature and recent studies on intestinal transplantation.
• Analysis of survival data for small bowel-alone and multivisceral IT.
• Identification of emerging immunosuppressive strategies and diagnostic markers.

Main Results:

• Early IT referral is recommended for life-threatening combined liver-intestinal failure or invasive desmoid tumors.
• No survival benefit was observed for IT in ultra-short bowel or PN catheter complications.
• One-year survival for small bowel-alone IT has risen to 80%, but five-year survival remains below 60%.

Conclusions:

• Refined indications for IT are crucial, particularly for complex cases.
• Long-term IT outcomes require improvement, despite advances in short-term survival.
• Future strategies include multivisceral grafts, novel immunosuppressants (Sirolimus, Thymoglobulins), and early rejection markers.