Intestinal and multivisceral transplantation

Sérgio Paiva Meira, Bianca Della Guardia, Andréia Silva Evangelista, Celso Eduardo Lourenço Matielo, Douglas Bastos Neves, Fernando Luis Pandullo, Guilherme Eduardo Gonçalves Felga, Jefferson André da Silva Alves, Lilian Amorim Curvelo, Luiz Gustavo Guedes Diaz, Marcela Balbo Rusi, Marcelo de Melo Viveiros, Marcio Dias de Almeida, Marina Gabrielle Epstein, Pamella Tung Pedroso, Paolo Salvalaggio, Roberto Ferreira Meirelles, Rodrigo Andrey Rocco, Samira Scalso de Almeida, Marcelo Bruno de Rezende

Intestinal transplantation has shown exceptional growth over the past 10 years. At the end of the 1990's, intestinal transplantation moved out of the experimental realm to become a routine practice in treating patients with severe complications related to total parenteral nutrition and intestinal failure. In the last years, several centers reported an increasing improvement in survival outcomes (about 80%), during the first 12 months after surgery, but long-term survival is still a challenge. Several advances led to clinical application of transplants. Immunosuppression involved in intestinal and multivisceral transplantation was the biggest gain for this procedure in the past decade due to tacrolimus, and new inducing drugs, mono- and polyclonal anti-lymphocyte antibodies. Despite the advancement of rigid immunosuppression protocols, rejection is still very frequent in the first 12 months, and can result in long-term graft loss. The future of intestinal transplantation and multivisceral transplantation appears promising. The major challenge is early recognition of acute rejection in order to prevent graft loss, opportunistic infections associated to complications, post-transplant lymphoproliferative disease and graft versus host disease; and consequently, improve results in the long run.