Background: Intestinal transplantation is an alternative to total parenteral nutrition (TPN) for the treatment of chronic intestinal failure. To determine the current status of small-bowel transplantation, we have reviewed the world experience since 1985.
Methods: We built up an international registry by asking twenty-five intestinal transplantation programmes to submit standard data on their cases operated on between 1985 and June, 1995.
Findings: One centre (two transplantations) did not use our report form, and these cases were excluded. The remaining twenty-four programmes did 180 transplantations in 170 patients. Two-thirds of the recipients were children. The main indication (64 percent) was short-gut syndrome, another 13 percent had a tumour. Of the grafts, 38 percent were small-bowel with or without colon, 46 percent were intestine plus liver, and 16 percent were multivisceral. Graft/patients' survival (percent) at 1 and 3 years under cyclosporin immunosuppression was, respectively: 17/57 and 11/50 for small bowel only; 44/44 and 28/28 for intestine plus liver; and 41/41 and 41/41 for multiviscera. The corresponding figures under tacrolimus were: 65/83 and 29/47; 64/66 and 38/40; and 51/59 and 37/43. 78 percent of the 86 survivors had stopped TPN and resumed oral nutrition.
Interpretation: Our approach cannot give data on long-term outcome. The short-term results of intestinal transplantation are similar to those of lung grafting. We conclude that small-bowel transplantation has become a life-saving option for patients who cannot be maintained on TPN and for those who require massive abdominal evisceration for locally aggressive tumours.