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Review
. 2017 Sep 1;33(3):135-141.
doi: 10.5152/turkjsurg.2017.3544. eCollection 2017.

Advances in small bowel transplantation

Alp Gürkan  1   2
Affiliations
Review

Advances in small bowel transplantation

Alp Gürkan. Turk J Surg. .

Abstract

Small bowel transplantation is a life-saving surgery for patients with intestinal failure. The biggest problem in intestinal transplantation is graft rejection. Graft rejection is the main reason for morbidity and mortality. Rejection has a negative effect on the survival of the graft. While 50%-75% of small bowel transplantation patients experience acute rejection, chronic rejection occurs in approximately 15% of patients. Immune monitoring is crucial after small bowel transplantation. Unlike other types of transplantation, there are no non-invasive or reliable markers to predict rejection in small bowel transplantation. The diagnosis of AR is confirmed by clinical symptoms, endoscopic appearance, and pathological specimens taken by endoscopy. Thus, histopathological examinations obtained by protocol biopsies remain as the gold standard for intestinal graft monitoring; however, biopsies have some complications, especially in small grafts. In addition to the high complication rate, biopsies are non-diagnostic; thus, multiple biopsies should be performed to exclude rejection. Therefore, auxiliary assays, such as measurements of citrulline and calprotectin in the blood, cytofluorographic examination of peripheral blood immune cells, cytokine profiling, and distinct gene-set-change measurements, are increasingly being used in small bowel transplantation. Developments in the understanding of genes seem to be promising that limited gene sets, taken from blood or from intestinal biopsies, will enhance pathological diagnosis. Bone marrow mesenchymal stem cell transplantation with SBT and tissue engineering are also promising procedures.

Keywords: Small bowel transplantation; intestinal transplantation; short bowel syndrome; small bowel insufiency; stem cell transplantation.

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Conflict of interest statement

Conflict of Interest: No conflict of interest was declared by the author.

Figures

Figure 1
Figure 1
Isolated intestinal graft
Figure 2
Figure 2
Mesenteric venous and arterial anastomosis of the small intestinal graft
See this image and copyright information in PMC

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