الفهرس 
Embryological originOnly 14 pages are availabe for public view
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Abstract
The evaluation of intestinal transplantation has spanned over 40 years; however, clinical success was only achieved in the last decade.
The use of Tacrolimus as the primary immunosuppressant in small bowel transplantation as well as improved surgical techniques, the availability of increased potent immunosuppressive medications, infection prophylaxis, and suitable patient selection have contributed to the reality of this procedure for a growing number of patients who are total parenteral nutrition dependent and have permanent intestinal failure.
The indications of living donor intestinal transplantation are the same as for cadaver intestinal transplantation. Briefly, Intestinal transplantation is indicated in patients with irreversible intestinal failure suffering from life-threatening total parenteral nutrition-related complications. Any patient who is candidate for cadaver Intestinal transplantation is candidate for living donor intestinal transplantation.
Short bowel syndrome, defective gastrointestinal motility, gastrointestinal neoplastic syndromes, impaired enterocytes function and other gastrointestinal disorders are the main causes of gut failure and indications for transplantation, either alone, combined with liver or as part of multivisceral graft that may include stomach, duodenum, pancreas, and the small bowel with or without the liver.
The contraindications for intestinal, liver-intestinal and multivisceral transplantation are either relative or absolute and include cardiopulmonary insufficiency, incurable malignancy, persistent life-threatening intra-abdominal or systemic infections, and immune deficiency syndromes.
The goals of patient evaluation for intestinal transplantation are to determine the cause and extent of the intestinal failure, to evaluate any associated organ dysfunctions, and to determine that appropriate therapy, including other surgical or medical options, have been already offered to the patient.
There are 3 types of operative procedures that are adapted to the need of the patient; isolated small bowel transplantation, combined liver-small bowel transplantation and a multivisceral transplant including the small bowel with liver, stomach and or pancreas.
Postoperative complications for living donor are the same as those for any major abdominal operation involving intestinal or colonic surgery. The major difference that no pathology is present in the bowel and the donor is perfectly and electively prepared for the surgery.
For recipient complications include rejection which can be acute or chronic, Graft versus host disease, Post transplant Lymphoproliferative disease & infection complications. Bacterial infections are the most prevalent infections, with an incidence of 80%. The incidence of fungal infection in intestinal transplant recipients has been estimated & the most relevant viral infections after intestinal transplant are those caused by cytomegalovirus and Epstein-Barr virus.
Surgical complications can cause graft loss. The most common are postoperative hemorrhage, vascular thrombosis, and the biliary leak or obstructions. Intestinal perforation, wound dehiscence, intra-abdominal abscesses, and chylous ascites but are an infrequent cause for graft loss.
As survival rates increase for intestinal transplantation recipients, with many patients having an extended survival of greater than 5 years, quality of life in intestine transplantation recipients is excellent. Intestinal grafting is cost-saving compared with maintenance home parenteral nutrition.
The International Regisrty report was established to evaluate results of intestinal transplantation and long term outcomes. It contains data on more than 1292 transplants that have been performed, 41 grafts (3.2) have come from living donors at 17 centers in seven different countries. Over half of the recipients are still alive today, with the longest patient survival 16 years with a functioning graft.
Now Intestinal Transplantation has become the treatment of choice for patients with end-stage gut failure and life threatening complications of parenteral nutrition with over 40 centers in North America and over 60 centers worldwide that have performed the challenging procedure.