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Seventeen years after successful small bowel transplantation: long term graft acceptance without immune tolerance
  1. F M Ruemmele1,
  2. F Sauvat1,
  3. V Colomb1,
  4. M Jugie1,
  5. D Jan1,
  6. D Canioni1,
  7. D Damotte1,
  8. S Sarnacki1,
  9. N Brousse1,
  10. Y Revillon1,
  11. O Goulet1
  1. Intestinal Transplantation Unit, Necker-Enfants Malades Hospital, Reference-Centre for Rare Digestive Diseases, AP-HP, Paris, INSERM U793, Faculté de Médecine, Université Paris-Descartes, France
  1. Correspondence to:
    Dr F M Ruemmele
    Paediatric Gastroenterology Unit, Hôpital Necker-Enfants Malades, 149 Rue de Sèvres, F-75743 Paris, Cedex 15, France; frank.ruemmele{at}nck.ap-hop-paris.fr

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The first attempts at small bowel transplantation (SBT) in humans were disappointing1–3 and characterised by severe graft rejection in spite of initially encouraging experience in animals.3–5 Major difficulties were encountered as: (1) the intestine is an immune organ harbouring most immune competent cells of the body; and (2) it is particularly vulnerable to ischaemia, not allowing time consuming HLA matching prior to transplantation (Tx). Therefore, Tx of intestinal allografts into fully immune competent recipients results almost inescapably in terminal graft rejection. With the introduction of tacrolimus in the 1990s, this difficulty was partially overcome, improving small bowel graft survival rates (70% at one year post Tx).6–8 However, on follow up, a large number of grafts are still lost, raising the question of long term success and benefit after SBT. Here we present the first patient with a 17 year follow up after isolated …

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