Small Bowel Transplantation

Small Bowel Transplantation

Small Bowel Transplantation - replacement of a diseased SMALL INTESTINE with a cadaver donor small intestine. Small bowel transplantation is a final treatment option for SHORT BOWEL SYNDROME or other circumstances in which there is total loss of small intestine structure or function. The gastroenterologist may consider small bowel transplantation when all other treatments, including total PARENTERAL NUTRITION, have failed. Small bowel transplantation is an extraordinarily complex procedure. The complication rate is high, and at present the three-year success rate is about 50 percent.

The small intestine produces numerous DIGESTIVE ENZYMES and DIGESTIVE HORMONES necessary for proper function of the entire gastrointestinal tract. One challenge with small bowel transplantation is the restoration of this production. Another challenge is the abundance of lymphatic tissue in the intestinal mucosa (mucous membrane that lines the inside of the small intestine). Researchers do not yet fully understand the role of this tissue, called GUT-ASSOCIATED LYMPHOID TISSUE (GALT). However, GALT appears to intensify the IMMUNE RESPONSE typical with transplanted organs, requiring large doses of IMMUNOSUPPRESSIVE MEDICATIONS such as cyclosporine. These medications suppress immune activity throughout the body, not only in the intestinal tract, resulting in significant risk for INFECTION. Up to a third of people who receive small bowel transplantation experience complications including organ rejection and infection during the first year.

See also CYSTIC FIBROSIS; GASTROENTERITIS; ORGAN TRANSPLANTATION.

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The Gastrointestinal System

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