Current results of intestinal transplantation

Background Intestinal transplantation is an alternative to total parenteral nutrition (TPN) for the treatment of chronic intestinal failure. To determine the current status of small-bowel transplantation, we have reviewed the world experience since 1985. Methods We built up an international registry by asking twenty-five intestinal transplantation programmes to submit standard data on their cases operated on between 1985 and June, 1995. Findings One centre (two transplantations) did not use our report form, and these cases were excluded. The remaining twenty-four programmes did 180 transplantations in 170 patients. Two-thirds of the recipients were children. The main indication (64%) was short-gut syndrome; another 13% had a tumour. Of the grafts, 38% were small-bowel with or without colon, 46% were intestine plus liver, and 16% were multivisceral. Graft/patients' survival (%) at 1 and 3 years under cyclosporin immunosuppression was, respectively: 17/57 and 11/50 for small bower only; 44/44 and 28/28 for intestine plus liver; and 41/41 and 41/41 for multiviscera. The corresponding figures under tacrolimus were: 65/83 and 29/47; 64/66 and 38/40; and 51/59 and 37/43. 78% of the 86 survivors had stopped TPN and resumed oral nutrition. Interpretation Our approach cannot give data on long-term outcome. The short-term results of intestinal transplantation are similar to those of lung grafting. We conclude that small-bowel transplantation has become a life-saving option for patients who cannot be maintained on TPN and for those who require massive abdominal evisceration for locally aggressive tumours.