[Small bowel transplantation. Animal experimental and clinical status]

Small bowel transplantation is a logical treatment in patients with the short bowel syndrome. The intestinal function can be permanently reestablished in animals with small bowel autografts. However, small bowel allotransplantation involves a considerable risk of immunological problems because of the large quantity of lymphoid tissue present in the graft. In non-immunosupprimized experimental animals, it triggers a vigorous rejection response and/or graft versus host disease (GVHD). The use of azathioprine and prednisone as immunosuppression has improved the graft survival minimally. The advent of cyclosporine has increased the survival of small bowel allografts in animal experiments considerably. Preoperative graft irradiation reduces the risk of GVHD. Monitoring of graft function is difficult. Histological evaluation of intestinal biopsy specimens is very useful and it can be combined with the determination of the absorptive function by 14C labelled carbohydrates (glucose, maltose). Twelve patients have undergone small bowel transplantation during the period 1964-1987. Eleven patients died a few weeks after the small bowel transplantation, the longest survivor died after 76 days (information is not available about the last small bowel transplanted patient). Four patients were treated with cyclosporine. Although the results so far have been depressing, a fundament has been created for further investigation in the field. Today, small bowel transplantation is an experimental treatment. It should only be considered for patients with serious and immediately life-threatening complications of the short bowel syndrome.