Recent developments in transplantation of the small intestine

The widespread application of intestinal transplantation depends upon achieving a success rate sufficiently high to warrant treating patients by transplantation rather than parenteral nutrition. This is analogous to the situation in renal transplantation (where the alternative is dialysis) and pancreatic transplantation (insulin treatment) and contrasts with the situation in liver and heart transplantation where there is no effective alternative therapy. The main barrier to success at this level is immunological; progress will depend on improved prevention, diagnosis and treatment of rejection. Although developments are expected of new and more potent immunosuppressive drugs, it is possible that acceptable long-term results will require a more fundamental manipulation of the immune response in order to achieve at least partial tolerance of the graft.