Abstract
Until very recently, outcomes from small bowel transplantation (SBTx) lagged behind those in liver, heart, and kidney transplantation because of the magnitude of the immunologic burden; the strong expression of histocompatibility antigens; and the contamination in grafts by bacterial organisms. With novel techniques of immune-induction therapies, such as recipient "preconditioning" with lymphocyte reduction, followed by the more subtle use of immunosuppression-based singleagent tacrolimus, graft and host 1-year survival is now over 90% in the most active US centers, a finding that parallels the outcomes in liver and kidney transplantation. In contrast to the alternative therapy for permanent intestinal failure, home total parenteral nutrition (TPN), SBTx improves quality of life and restores digestive and absorptive function, making patients nutritionally autonomous. With survival beyond 1 to 3 years, the procedure is cost-effective. Current results support expansion of the indications for SBTx from use as salvage therapy for patients with TPN failure to preemptive therapy for patients at risk of developing TPN failure.
Similar content being viewed by others
References and Recommended Reading
Dudrick SJ, Wilmore DW, Vars HM, Rhoads JE: Long-term total parenteral nutrition with growth, development, and positive nitrogen balance. Surgery 1968, 64:134–142.
Abu-Elmagd KM, Bond G, Matarese L, et al.: Gut rehabilitation and intestinal transplantation. Therapy 2005, 2:853–864. Provides an up-to-date review of the state of the art of current SBTx in the United States.
Abu-Elmagd K: The history of intestinal transplantation. In The History of Organ and Cell Transplantation. Edited by Hakim NS, Papalois VE. London: Imperial College Press; 2003:171–193.
Fishbein TM, Matsumoto CS: Intestinal replacement therapy: Timing and indications for referral of patients to an intestinal rehabilitation and transplant program. Gastroenterology 2006, 130:S147-S151.
Abu-Elmagd K, Reyes J, Bond G, et al.: Clinical intestinal transplantation: a decade of experience at a single center. Ann Surg 2001, 234:404–416.
Medicare Coverage Policy Decisions, Intestinal and Multivisceral Transplantation. CAG-00036, October 4, 2000. A landmark document that first acknowledged the role of and potential insurance coverage for SBTx in the management of TPN-failure.
Abu-Elmagd KM: Intestinal transplantation for short bowel syndrome and gastrointestinal failure: Current consensus, rewarding outcomes, and practical guidelines. Gastroenterology 2006, 130:S132-S137
Grant D, Abu-Elmagd K, Reyes J, et al.: 2003 report of the intestine transplant registry: A new era has dawned. Ann Surg 2005, 241:607–613. The latest international figures in outcome from SBTx are provided in this report.
Pironi L, Hebuterne X, Van Gossum A, et al.: Candidates for intestinal transplantation: a multicenter survey in Europe. Am J Gastroenterol 2006, in press.
O’Keefe SJD: Candidacy for small bowel transplantation. (editorial). Am J Gastroenterol 2006, in press.
Berney T, Genton L, Buhler LH, et al.: Five-year follow-up after pediatric living related small bowel transplantation between two monozygotic twins. Transplant Proc 2004, 36:316–318.
Testa G, Holterman M, John E, et al.: Combined living donor liver/small bowel transplantation. Transplantation 2005, 79:1401–1404.
Wu T, Bond G, Martin D, et al.: Histopathologic characteristics of human intestine allograft acute rejection in patients with tolergenic immunosuppression. Transplantation 2004, 78(Suppl):O59.
Byrne TA, Wilmore DW, Iyer K, et al.: Growth hormone, glutamine, and an optimal diet reduces parenteral nutrition in patients with short bowel syndrome: a prospective, randomized, placebo-controlled, double-blind clinical trial. Ann Surg 2005, 242:655–661.
Jeppesen PB, Hartmann B, Thulesen J, et al.: Glucagon-like peptide 2 improves nutrient absorption and nutritional status in short-bowel patients with no colon. Gastroenterology 2001, 120:806–815.
Jeppesen PB, Sanguinetti EL, Buchman A, et al.: Teduglutide (ALX-0600), a dipeptidyl peptidase IV resistant glucagon-like peptide 2 analogue, improves intestinal function in short bowel syndrome patients. Gut 2005, 54:1224–1231.
O’Keefe SJD: Small bowel transplantation (SBTx) improves nutrition, liver function, and quality of life (QoL) in patients with permanent intestinal failure. Presented at the IXth International Small Bowel Transplantation Symposium. Brussels, Belgium: June 30–July 2, 2005.
Sudan D: Cost and quality of life after intestinal transplantation. Gastroenterology 2006, 130:S158-S162
Sudan D, Horslen S, Botha J, et al.: Quality of life after pediatric intestinal transplantation: the perception of pediatric recipients and their parents. Am J Transplant 2004, 4:407–413
Abu-Elmagd KM, Reyes J, Fung JJ, et al.: Evolution of clinical intestinal transplantation: improved outcome and cost effectiveness. Transplant Proc 1999, 31:582–584.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
O’Keefe, S.J.D., Matarese, L. Small bowel transplantation. Curr Gastroenterol Rep 8, 360–366 (2006). https://doi.org/10.1007/s11894-006-0020-x
Issue Date:
DOI: https://doi.org/10.1007/s11894-006-0020-x