Advances in Small Bowel Transplantation
Abstract
Small bowel transplantation (SBT) is a life saver procedure in patients with intestinal failure. The biggest obstacle to intestinal transplantation is graft rejection. It is the main factor in morbidity and mortality. Rejection has a negative impact on survival of the graft. The acute rejection occurs in 50-75% and the chronic rejection occurs in 15% of the patients.
Immune monitoring is crucial after SBT. Unlike other types of transplantation, the intestine lacks a reliable and minimally invasive marker to predict rejection. The diagnosis of acute rejection is performed by clinical, endoscopic and pathologic anatomy. Protocol biopsies and histological analysis remain the gold standard for allograft monitoring, but neither is free of complications, especially in smaller grafts. Up to 30% of biopsies are nondiagnostic and multiple biopsies may be required to exclude rejection. So, ancillary assays are increasingly used in SBT such as measurements of citrulline and calprotectine in the blood, cytofluorographic analysis of peripheral immune cell population, cytokine profiling and the quantitation of distinct gene set changes. Developments in understanding of genes provide promise 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 promising procedures.
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DOI: http://dx.doi.org/10.18103/imr.v1i1.19
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