General

Small bowel transplantation:

Indications and graft survival:

Recipients of small bowel transplantation are patients who are not able to endure chronic parenteral nutrition after intra-abdominal catastrophes (e.g. volvulus, toxic enterocolitis). Patient survival rate at one year is depending on graft-versus-host reaction inducing greater risk than in other vascularized organ allografts. The potential of living related donation for small bowel allografts is currently already being performed in selected cases.

Preservation and transplant procedures:

Cold ischemic time should be no longer than 7 to 12 hours. The technique of isolated small bowel transplantation and combined liver-small bowel transplantation represents a high risk procedure. Over the last years, the rate of surgical complications leading to graft reconstruction has been considerably reduced. The updated technique of combined liver-small bowel transplantation has virtually eliminated the risk of biliary complications.

Complications:

In contrast to other transplanted organs, small bowel possesses a physiologic inflammatory site. This explains the current high rate of infectious complications and rejections in patients receiving an intestinal transplantation.

Multi-organ transplantation

Multi-organ transplantations are performed more frequently in recent years. Liver transplantation combined with kidney, pancreas, small bowel and lung are a part of multi organ replacement. Results are however still poor.