History

Intestinal transplantation techniques were developed in animal models in 1959 and first attempted in humans in 1964 [2]. In those days, immunosuppres-sion consisted of steroids and azathioprine after induction with an antilymphocyteglobulin. Under this type of rejection prophylaxis, altogether eight isolated intestinal transplants were performed. The first two transplants performed in Boston in 1964, however, have never been officially reported as files remain untraceable. The first well-documented case was reported from Minneapolis in 1967 [3]. Under unconventional immunosuppression, all but one graft failed within a few days. The last graft in this series was from a HLA identical sister and survived for 79 days. The recipient was able to be fed orally from day 23 until day 60 [4].

The first bowel transplant in the Cyclosporine era was performed in 1985 in Toronto [5]. Patient No. 8 in this series received 60 cm of jejunoileum from her sister in 1988 and became the first long-term survivor. It has to be said, however, that oral food intake was never sufficient and had to be supplemented by parenteral infusions. The patient experienced several episodes of rejection, developed end-stage renal disease and died a few years later [6].

On March 19, 1989, a 5-month old girl received 80 cm of jejunoileum from a neonate. This patient transplanted in Paris is still alive and well with a normally functioning graft [7]. Already in 1960, Starzl reported on a series of multivisceral transplants in dogs [8]. The same author performed the first human multivisceral transplant in 1983 in a 6-year-old girl in Pittsburgh. The girl, however, died only a few hours after surgery from exsanguination. The same happened to a 1-year-old male who underwent transplantation in 1986 in Chicago. In 1987, Starzl performed another transplantation in a 3.5-year-old girl and Williams in Chicago did the same in the following year in a 0.7-year-old neonate. Both children died 192 and 109 days, respectively, after transplantation from lymphoma. The type of IS consisted of OKT3 induction followed by cyclosporin and steroids. Both children were never discharged from the hospital [9,10]. On December 26,1989, a multivisceral transplant was carried out for the first time in an adult recipient

48 years of age in Innsbruck. This patient lived on oral food intake for 9 months when he died from tumor recurrence [11].

On November 13, 1988, Grant performed the first combined small-bowel/liver transplantation in London/Ontario in a 41-year-old woman with short-gut syndrome with a hypercoagulable state associated with low antithrombin III levels. The patient survived for several years [12].

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