Anaesthesia for intestinal transplantation

Abstract

The first small-bowel transplant occurred in the late 1980s, and since then intestinal transplantation has become an established treatment for patients with permanent intestinal failure. Between 1985 and 2007, 1720 intestinal transplants were performed worldwide. Intestinal transplantation has the potential to restore digestive and absorptive function and liberate patients from long-term parenteral nutrition (PN), thereby considerably improving subjective quality of life. Modern day approaches to immunosuppression, surgical, and anaesthetic management of these patients has led to improved shortand long-term survival rates, with patient and graft survival at 1 yr of 81 and 73.4%, respectively. If the patient and graft survive beyond 1–3 yr, intestinal transplantation becomes cost-efficient when compared with PN and its associated complications. More than 60 intestinal transplantation centres now exist worldwide. Adult UK centres include Oxford, Cambridge, and Leeds, with paediatric services in London and Birmingham (Fig. 1).