ABSTRACT
In the meantime, patients with chronic intestinal failure have been managed with parenteral nutrition (PN) which has developed to the point where 75% of patients can expect to survive 10 years.7 There are 33 centers carrying out small bowel transplantation world wide (commu nication Dr. D Grant, 5th International Symposium on Intestinal Transplantation, Cambridge 1997), but only patients who are experiencing complications with parenteral nutrition or feel that their quality of life is intolerable are selected as candidates for intestinal transplantation.8"10 In the UK, around 250 patients are identified as being on home PN which equates to 4 per million and 50% of these could be considered potential recipients for intestinal transplantation.11' 13
The reason successful intestinal transplantation has been hard to achieve is because 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 normal circumstances and the patchy nature of rejection; and the gut is continually exposed to bacteria, fungi and food antigens resulting in high rates of 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 trans plantation). The current 5-year survival after intestinal transplantation is 50%, although there is a “center effect” with the large North American centers achieving 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).
