Small Intestinal Transplantation: An Update

Organ transplantation is indeed a revolution in management of end-stage organ failure. The one year graft survival rates for solid organs now routinely exceed 85 per cent for the kidney, liver and heart. The enhanced success rate is due to better immunosuppression, improvement in surgical techniques, organ preservation and better understanding of the immunology of rejection. The small intestine has been more difficult to transplant than other organs due to its strong expression of HLA antigens, large amount of lymphoid tissue and presence of micro-organisms. Early attempts to transplant the small bowel failed due to severe rejection and sepsis. The early 1990s witnessed improvements in graft survival, however, survival rates were still inferior to other organ transplants. In recent years, individual centres have reported improved outcomes with better long-term graft survival.