Can intestinal transplantation constitute treatment for intestinal failure?

The management of patients with intestinal failure has benefited from progress in parenteral nutrition (PN), especially home-based parental nutrition. Intestinal transplantation is now possible and in some conditions, constitutes the logical treatment option. Since 1985, more than 300 small-bowel grafts have been performed, involving the isolated small bowel with or without the colon (45 %), the liver + small bowel (40 %) or several organs (15 %). 2/ of recipients were under 20 yeats of age, and indications were short-bowel syndrome (64 %), severe intractable diarrhea (13 %), abdominal cancer (13 %), or chronic intestinal pseudo-obstruction syndrome (8 %). 51 % of patients survived > 2 years after the graft. Patient and graft survival depends on the type of immunosuppression, i.e. Ciclosporine or FK 506. The results must be interpreted carefully as they represent the first experience in numerous centers using different immunosuppressive protocols, without any randomization. The results from the largest of these centers more closely reflect the current situation and may exceed a 70 % 2-year survival rate. Functional grafts lead to gastrointestinal autonomy (weaning of PN) while maintaining satisfactory nutritional status and normal growth in childhood. Intestinal transplantation is theoretically indicated for all patients permanently or persistently dependent on PN. However, as PN is generally well tolerated, even for long periods, each indication for transplantation must be carefully weighed up in terms of the iatrogenic risk and quality of life. When PN has reached its limits, especially those associated with vascular, infectious, hepatic or metabolic complications, intestinal transplantation must be undertaken. Transplantation of the small bowel alone remains the first option, as combined liver-small bowel grafting is only indicated in case of life-threatening progressive cirrhogenic liver disease.