History of Intestinal Transplantation
The first small intestinal transplantation reported in humans was undertaken in Minnesota by Lillehei and colleagues in 1967. Here a small segment of duodenum was included in a pancreas transplantation. Although this was not any where near enough small intestine to have any significant digestive function, it was considered a first very small success in the area and provided a limited proof of concept that the intestine could be transplanted at least a very small piece of it.
However, over the next 20 years, when larger segments were transplanted in order to restore oral nutrition, there was universal failure. The main problems were rejection and infection. With the introduction of immunosuppression first with azathioprine in the late 1960’s, then cyclosporine in the late 1970’s, intestinal transplantation was still out of reach.
However, finally in the late 1980’s, Grant and colleagues, successfully transplanted liver and intestine and achieved long-term survival and oral nutrition using cyclosporine immunosuppression. Subsequently, with the introduction of tacrolimus (an even more potent immunosuppressive agent) transplantation of the intestine became increasingly successful.
Acute rejection of the intestine is now quite uncommon and has been replaced by sepsis as the major post operative complication and cause of death. Survival seems now to be more related to careful preoperative preparation and scrupulous post operative management of patients.
NASIT Forum meeting – Dates & locations
Monday 5 March 2018 - John Radcliffe Hospital
Headley Way, Headington
Thursday 10 May 2018 - The Hope