La transplantation intestinale : Indications et stratégie

Abstract

Intestinal transplantation is a valid therapeutic option for adults and children with irreversible intestinal failure, and not only for short bowel syndrome. The use of tacrolimus, monoclonal antibodies and antiviral therapy has improved both graft and patient survival. The lesser severity of graft rejection in combined liver-small bowel transplantation, as well as the safety of associated colon grafting, are now well established. Long-term intestinal graft function may be totally restored, allowing maintenance in adults and normal growth in children after weaning from parenteral nutrition. ITx is indicated only for selected patients with irreversible intestinal failure in whom long-term PN is no longer a safe option. The medico-surgical therapeutic strategy must be discussed early in order to ensure that ITx is performed at the right time in optimal conditions.