ABSTRACT
Successful preservation of the small bowel has presented unique challenges because of the hollow nature of the organ, its increased ability to develop intestinal edema under minimal conditions of physiological stress and its unique immune and bacterial environment. In addition to the fundamental preservation principles established by studying other organs, the small bowel also has special metabolic needs that must be addressed to preserve the mucosal barrier and achieve normal metabolism and function.1 Despite early developments in transplantation techniques and preservation of the small bowel during the late-1950s through the 1970s, few significant changes occurred in the 1980s and 90s.2'24 In the last decade and a half, however, transplantation of the small bowel has been reintroduced as a potential treatment for end-stage small bowel disease (ESSBD), mainly represented by the short bowel syndrome.25 Presendy, more than 100 clinical small bowel transplants are performed in the United States annually. (U N O S, 2008) In the clinical arena, recipient survival greater than 3 years after small bowel transplantation is 65% and graft survival is approximately 50%. The longest survival is obtained when small bowel transplants are associated with liver and other organs in a cluster operation.26 This chapter will review the historical background and the preservation of the small bowel for transplantation.
