Intestinal Transplantation from Living Donors

Intestinal transplantation (ITx) represents the physiologic alternative to total parenteral nutrition (TPN) for patients suffering from life-threatening complications of irreversible intestinal failure. The number of transplants performed worldwide has been increasing for several years until recently. ITx has recently become a valid therapeutic option with a graft survival rate between 80 % and 90 % at 1 year, in experienced centers. These results have been achieved due to a combination of several factors: better understanding of the pathophysiology of intestinal graft, improved immunosuppression techniques, more efficient strategies for the monitoring of the bowel graft, as well as control of infectious complications and posttransplant lymphoproliferative disease (PTLD). In fact, this procedure is associated with a relatively high rate of complications, such as infections, acute rejection, graft versus host disease (GVHD), and PTLD, if compared to the transplantation of other organs. These complications may be, at least in part, the consequence of the peculiarity of this graft, which contains gut-associated lymphoid tissue and potentially pathogenic enteric flora. Furthermore, in these patients, the existing disease and the relative malnutrition could predispose them to infectious complications. Additionally, other factors associated with the procedure, such as laparotomy, preservation injury, abnormal motility, and lymphatic disruption, could all be implicated in the development of complications.