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Current outcomes after pediatric and adult intestinal transplantation

Amin, Arpit; Farmer, Douglas G.

Current Opinion in Organ Transplantation: April 2019 - Volume 24 - Issue 2 - p 193–198
doi: 10.1097/MOT.0000000000000608
SMALL BOWEL TRANSPLANTATION: Edited by Douglas G. Farmer
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Purpose of review In this article, we will review the outcomes of patients with intestinal transplant (ITx) with a focus on factors affecting long-term graft and patient survival.

Recent findings The most recent International Intestinal Transplant Registry reports a 1-, 5-, and 10-year graft survival of 71%, 50%, and 41% respectively, for ITx grafts transplanted since 2000. Over the past decades, significant improvements have been achieved in short-term graft and patient outcomes for ITx recipients. The improvement in short-term outcomes may be related to the focused treatment of antihuman leukocyte antigen antibodies, the use of induction immunotherapy protocols, refinements in surgical techniques, establishment of dedicated ITx units, and improved postoperative management.

However, long-term graft and patient outcomes for ITx recipients remain stagnant. Issues impairing long-term outcomes of ITx include the challenges in the diagnosis and treatment of chronic rejection and antibody-mediated rejection, progressive decline in renal function, and long-term infectious and malignancy risks especially related to cytomegalovirus, Epstein–Barr virus and posttransplant lymphoproliferative disorder after ITx.

Summary Addressing and preventing early and late complications is the key to improving short-term and long-term outcomes after ITx.

Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA

Correspondence to Douglas G. Farmer, MD, 757 Westwood Plaza, Suite 8501, Los Angeles, CA 90095, USA. Tel: +1 310 267 9612; fax: +1 310 267 3590; e-mail: dgfarmer@mednet.ucla.edu

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