ABSTRACT
The reason successful intestinal transplantation has been hard to achieve is be cause of several unique characteristics: the great mass of lymphoid tissue in the gut renders it highly immunogenic; accurate identification of rejection episodes in the gut is difficult because of the presence of large numbers of lymphocytes under nor mal circumstances and the patchy nature o f rejection; and the gut is continually exposed to bacteria, fungi and food antigens resulting in high rates o f sepsis when gut integrity is damaged (as during rejection).14 Furthermore, the newly engrafted bowel seems to take longer than other organs to recover from the effects of ischemia and hypoxia incurred during harvesting and preservation, and intestinal function may take many months to stabilize (compared with an average of 2-3 weeks after liver transplantation). The current 5-year survival after intestinal transplantation is 50%, although there is a “center effect” with the large North American centers achiev ing better figures than this and smaller centers with less than 10 patients achieving less (personal communication Dr. David Grant, 5th International Symposium on Intestinal Transplantation, Cambridge 1997).
