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Intestinal transplantation: current improvements and perspectives

Goulet, Oliviera; Sauvat, Frédériqueb

Current Opinion in Organ Transplantation: June 2007 - Volume 12 - Issue 3 - p 265–270
doi: 10.1097/MOT.0b013e32814a5a3b
Small bowel transplantation

Purpose of review: This review summarizes the most recent relevant knowledge in clinical practice in the field of intestinal transplantation.

Recent findings: Three important factors that have allowed improving results during the last few years are reviewed here. The first relates to the development of a different approach to tackle the underlying cause of intestinal failure and to the patient's characteristics in terms of liver function, age, and body size. The second involves immune modulation and especially the immunosuppressive regimen at induction. The third refers to posttransplantation monitoring, in particular the diagnosis and treatment of intestinal graft rejection and lymphoproliferative disorders. Patient status and referral for intestinal transplantation remain debated. The Intestinal Transplant Registry and a report from an individual program have demonstrated the relationship between a patient's pretransplant status and outcome. Candidacy for intestinal transplantation was analysed in a European survey of home parenteral nutrition patients. Early referral and listing are important for successful outcomes after intestinal grafting.

Summary: Patient management should include therapies adapted to each stage of intestinal failure based on a multidisciplinary approach in centers involving surgery, gastroenterology, parenteral nutrition expertise, home parenteral nutrition programs, and liver–intestinal transplantation experience. Timing for referral of patients in specialized centers remains a crucial issue.

aDepartment of Pediatric Gastroenterology, Hepatology and Nutrition, National Reference Center for Rare Digestive Diseases

bDepartment of Pediatric Surgery and Transplantation, Necker–Enfants Malades Hospital, University Paris 5 – René Descartes, Paris, France

Correspondence to Olivier Goulet MD PhD, Hôpital Necker – Enfants Malades, University of Paris 5 – René Descartes, 149 Rue de Sèvres, 757015 Paris, France Tel: +33 1 44 49 25 60; fax: +33 1 44 49 25 01; e-mail: olivier.goulet@nck.aphp.fr

© 2007 Lippincott Williams & Wilkins, Inc.