New techniques for prevention and treatment of rejection in intestinal transplantation

Prevention and treatment of rejection is the most difficult and most important dilemma in clinical intestinal transplantation. Early detection of rejection and timely initiation of treatment are critically important for the treatment of intestinal transplant recipients. The recent introduction of daclizumab as a third agent to be administered with corticosteroids and tacrolimus for induction therapy has improved early postoperative outcomes. Although biochemical markers and functional tests have not been effective in monitoring rejection, the advanced technology of zoom endoscopy offers enhanced capabilities for more accurate evaluation of small bowel graft rejection and timely initiation of treatment. Once rejection progresses to the severe stage, it can seldom be reversed, and early graft enterectomy or retransplantation may afford the only means for survival.