In Safe Hands
Cambridge University Hospital
NHS Trust,
Cambridge
John Radcliffe Hospital
Oxford
St. Mark's Hospital,
Unit
Watford Road Harrow
Salford Royal NHS
Foundation Trust Hospital
Manchester
Call:
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Acute rejection of the intestine is now quite uncommon and has been replaced by sepsis as the major post operative complication and cause of death.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.
Patients can be referred directly to an intestinal transplant centre, or to an Intestinal Failure Unit. In addition, patients can be presented for consideration at the NASIT Forum meetings ...
The UK National Adult Intestinal Transplant Program provides isolated intestine (small bowel), combined liver and intestine, and multivisceral transplantation for patients who have irreversible intestinal failure. ...