Update on intestinal transplantation for the intensivist

This article provides an overview of intestinal transplantation, focusing on perioperative management and the recognition and treatment of complications in the intensive care unit. The review aims to update intensivists with a comprehensive understanding of the care of intestinal transplant recipients.

Despite advances in immunosuppression, donor graft preparation, perioperative care, and the management of complications such as rejection, graft-versus-host disease, and infection, graft and patient survival rates following intestinal transplantation have not improved over the past decade and remain inferior to those of other solid organ transplants. Although surgical techniques have largely remained unchanged, some transplant centers have reported performing intestinal transplantation without a stoma and utilizing preoperative embolization in selected cases.Recent updates in maintenance immunosuppression include the expanded use of less commonly employed agents as part of multimodal regimens such as mammalian target of rapamycin inhibitors and antimetabolites as well as the introduction of therapies not traditionally used for maintenance, including costimulatory blockade, interleukin-2 receptor blockade, and vedolizumab.

In recipients of intestinal transplants, prompt identification of infections and complications such as rejection, posttransplant lymphoproliferative disorder, and graft-versus-host disease is essential. Early recognition and intervention are critical to preserving graft function and improving overall survival. Effective management of these perioperative challenges requires a multidisciplinary team approach, with intensivists playing a central role in achieving optimal outcomes.