Current state of adult intestinal transplantation in Europe

In Europe, adult intestinal transplantation (ITx) has continuously evolved since the first successful case in 1989. However, despite several recent innovations, no significant improvement in survival has been seen since 2005, illustrating the unique difficulty of transplanting the intestine. In this review, a subanalysis of adult ITx in Europe is discussed and recent publications on adult ITx in Europe are presented.

Increased medical and surgical arsenal in the treatment of intestinal failure reduce the need for ITx. At the same time, new indications (diffuse ischemia) have emerged. Static cold storage after vascular flush remains the gold standard but promising results are shown with additional luminal preservation. Pretransplant embolization facilitates multivisceral transplantation. Chronic rejection remains a major difficulty to tackle and currently, liver inclusion is the only effective strategy. Treatment of graft-versus-host-disease remains debated. Quality of life substantially improves after successful ITx. ITx becomes cost-effective three years after transplantation.

ITx remains more challenging than other solid organ transplants. However, long term outcome, particularly after combined liver and ITx, is excellent and similar to other solid organ transplants. Further studies are warranted to tackle the fundamental immunobiological challenge that ITx represents.