AIM:Isolated small bowel transplantation is becoming the treatment of choice for adult patients with serious parenteral nutrition (PN) related complications: we report our three-year experience (December 2000-December 2003) from a single Italian center (Modena-Italy), with one of the larger European series.METHODS:We transplanted 14 patients, with a previous mean PN course of 27 months and a mean 21-month post-transplantation follow-up (range 3-36 months), obtaining a one-year actuarial survival rate of 92.3% with no intraoperative deaths.RESULTS:We lost 1 patient (7.2%), died for post-transplantation overwhelming sepsis following Cytomegalovirus (CMV) enteritis. Thirteen patients are alive, with one-year actuarial graft survival rate of 85.1%: 1 patient underwent graft removal (7.2%) for intractable severe acute rejection. Our immunosuppressive regimen was based on tacrolimus and 3 induction protocols: daclizumab (8 patients) with steroids, alemtuzumab (4 patients) and thymoglobulin (2 patients) without steroids. In 9 cases, we added sirolimus. Nine recipients experienced 22 episodes of acute cellular rejection (ACR), treated successfully in all cases but one. One patient (7.2%) was treated successfully for Post Transplant Lymphoproliferative Disease (PTLD) and is disease-free after 8 months.CONCLUSIONS:Small bowel transplantation can achieve optimal results depending on appropriate immunosuppressive management and candidate selection, added to shorter ischemia time and careful donor and graft selection.

Even when considering the possibility of organ rejection and the complications of immunosuppression, the risks associated with total parenteral nutrition therapy are life-threatening. Therefore, for patients with end-stage bowel disease small bowel transplantation (SBTx) is the only therapeutic option. The preferred method to procure these organs is debated, especially when, graft retrieval is associated with concurrent abdominal organ procurement of the pancreas, which shares part of the vascular inflow and outflow with the small bowel. While many surgeons procure the graft using the en bloc method, dissecting tissue at the back table, our preference is to use an in vivo technique, which results in shorter cold ischemia times and less bleeding during reperfusion of the pancreas/small bowel as well as decreased ascites production during the postoperative period and less edema and capsular bleeding of the pancreatic grafts. This article presents an analysis of 19 multiorgan cadaveric procurements using the in vivo technique with a focus on the quality of pancreas/small bowel postreperfusion properties during the first 5 to 6 postoperative months.

La insuficiencia intestinal se define como la pérdida de la autonomía nutricional debido a disfunción intestinal. Su única opción de tratamiento adecuado es la Nutrición Parenteral Total Central. El trasplante de intestino se presenta como una alternativa de tratamiento.Los resultados iniciales del trasplante de intestino evidenciaron una alta incidencia de rechazo, infección y complicaciones técnicas que frenaron el desarrollo de esta técnica, sin embargo con la disminución de los problemas técnicos por la experiencia acumulada y la mejoría de los tratamientos inmunosupresores los resultados mejoraron en forma importante. Si bien en Chile la experiencia es limitada la indicación para su realización existe y aumenta debido al interés creciente por los buenos resultados demostrados a nivel mundial.En este breve artículo se revisan las indicaciones y contraindicaciones del procedimiento, el estudio del receptor y del donante, la técnica de procuramiento y se analizan los resultados actuales y las perspectivas futuras.Intestinal insufficiency is defined as the loss of nutricional autonomy as a result of intestinal malfunction. The only adequate treatment option is Total Central Parenteral Nutrition. Intestinal transplantation is proposed as a treatment alternative.Initial intestinal transplantation results showed a high incidence of rejection, infection and technical complications that stunted the development of this technique. Results have however greatly improved with the enhancement of immunosuppressive therapy and increased experience which has led to a subsequent decrease in technical problems.Even though Chile has limited experience, the demand for intestinal transplantation exists and increases due to a rising interest brought about by the good results presented worldwide.This short article addresses the indications and contraindications of this procedure, receptor and donor studies, the procurement technique and also analyzes current results and future prospects.