Small bowel transplantation : immunological and functional studies

textabstractSmall bowel transplantation (SBT) would be the treatment of choice for patients suffering from the short bowel syndrome. Although in some centers SBT in patients is done with a considerable degree of success (Grant et al 1990, Todo et al. 1992), it is by no means an established and widely applicable therapy for those with short bowel syndrome. The small bowel is unique among vascularized organ grafts because it not only elicits a vigorous rejection reaction, but is also capable of inducing graft-versus-host disease (GVHD). Rejection of the graft does not only lead to loss of function, but also to bacterial translocation. The risk of fatal sepsis is aggravated by the immunosuppression given to prevent rejection. This chapter describes the history of experimental and clinical SBT, and outlines recent developments and future prospects concerning this theoretically optimal treatment modality for patients who would be dependent on total parenteral nutrition (TPN) for life.