Current indications for and prospects of living related intestinal transplantation

The potential advantages of living-related segmental small bowel transplantation include better matching; lessening the risk and severity of rejection; minimizing the need for immunosuppressive drugs and decreasing their side effects; protecting the intestinal integrity and preventing bacterial translocation; and obviating space limitations for grafts. In contrast, shorter lengths of bowel (segments) absorb less than entire intestines, and there is a small but definite risk of donation for the donor. The technical questions still being studied include the use of portal versus systemic drainage, the segment of intestine to be transplanted (ileum versus jejunum), and the need for an ostomy and the timing of its closure. The recent experience with living-related segmental transplants includes three at Tulane, a 4-year survivor in Kiel, Germany), and several others (for a total of about 15) in the United States, China, Japan, and England. There have been few transplants between identical twins; one at Stanford functioned for several years. Overall, the results have been good, but considerably more experience is needed before the exact role of this technique is completely established.