Update on intestinal transplantation for the intensivist.

Area of Science:

• Gastroenterology
• Transplant Surgery
• Critical Care Medicine

Background:

• Intestinal transplantation is a complex procedure with significant challenges.
• Graft and patient survival rates have stagnated over the last decade.
• Advances in immunosuppression and perioperative care have not yet translated to improved long-term outcomes.

Purpose of the Study:

• To provide an overview of intestinal transplantation.
• To focus on perioperative management and intensive care unit (ICU) complication recognition and treatment.
• To update intensivists on the comprehensive care of intestinal transplant recipients.

Main Methods:

• Review of current literature on intestinal transplantation.
• Analysis of perioperative management strategies.
• Discussion of common complications and their management in the ICU.

Main Results:

• Graft and patient survival rates remain inferior to other solid organ transplants.
• Surgical techniques are largely unchanged, with some centers exploring stoma-free procedures and preoperative embolization.
• Updated immunosuppression regimens include mTOR inhibitors, antimetabolites, costimulatory blockade, IL-2 receptor blockade, and vedolizumab.

Conclusions:

• Prompt identification and intervention for infections and complications (rejection, PTLD, GVHD) are essential.
• Early management is critical for preserving graft function and improving survival.
• A multidisciplinary team approach, with intensivists playing a key role, is vital for optimal outcomes.