Introduction

Bowel transplantation has become a valuable option for patients with intestinal failure or short-bowel syndrome who do not tolerate total parenteral nutrition or have no vascular access for TPN. Up until March 31, 2005, a total of 1292 intestinal transplants (in altogether 1210 patients) have been reported to the international registry. Of these 1292 transplants, 570 of them were isolated small-bowel transplants, 490 combined small-bowel/liver transplants, and 232 were multivisceral transplants. Additionally, 772 transplants were performed in 721 pediatric recipients and 520 transplants in 489 adult patients [1].

It goes without saying that no bowel transplantation was done for inflammatory bowel diseases in the pediatric group, but 68 transplants were performed in adults for this indication. In total, we have experience with 16 isolated small-bowel transplants and ten multivisceral transplants, and four of the isolated intestinal transplants in three patients were performed for Crohn's disease.

Presently, appropriate indications, the timing of referral and the outcome of bowel transplantation are not well recognized among physicians caring for patients who may be candidates for this therapeutic option. Definitions of terms such as "intestinal failure" and "failure of parenteral nutrition" are not standardized and there is no accepted algorithm that integrates parenteral nutrition, intestinal rehabilitation and transplantation for patients with intestinal failure.

Herein, with special emphasis on inflammatory bowel diseases, we review the various aspects of bowel transplantation such as the indications for it, the current state of medical practice in intestinal transplantation, and its outcome.

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