Intestinal Transplantation Techniques and Outcomes
Summary
Intestinal transplantation has evolved from a rare experimental procedure into a well-established therapy for irreversible intestinal failure. Techniques range from isolated small-bowel grafts to complex multivisceral programmes that may include liver, pancreas, stomach and colon. Advances in donor procurement, refined vascular anastomoses and innovative approaches to abdominal wall closure have reduced perioperative morbidity and blood loss. Despite these technical gains, the intestine remains exceptionally immunogenic, with acute rejection rates exceeding those of other solid organs. Contemporary immunosuppressive regimens combine calcineurin inhibitors, antimetabolites and targeted biologicals to strike a balance between graft tolerance and infection or malignancy risk. Survival rates now commonly exceed 85 per cent at one year and 60 per cent at five years post-transplant, with many recipients achieving full enteral autonomy and markedly improved quality of life. Global collaboration, centralisation of services and standardised reporting have further optimised outcomes, while ongoing work seeks non-invasive biomarkers for early detection of graft injury and personalised immunosuppression protocols. Emerging strategies, such as inclusion of the colon in visceral allografts, aim to enhance absorptive capacity and patient well-being. Collectively, these developments underscore the maturation of intestinal transplantation into a robust, life-restoring intervention with clear pathways for future innovation.
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Intestinal Transplantation Techniques and Outcomes publication trend
The graph below shows the total number of articles in intestinal transplantation techniques and outcomes across all publications each year (not limited to Nature Index journals).
Technical terms
Allograft: A transplanted organ or tissue from a genetically non-identical donor of the same species.
Acute cellular rejection: Rapid immune-mediated injury of the transplanted intestine characterised by lymphocytic infiltration and epithelial damage.
Donor-specific antibodies (DSA): Recipient antibodies directed against donor human leucocyte antigens, associated with increased risk of graft loss.
Multivisceral transplantation: En bloc transplantation of multiple abdominal organs, often including intestine, liver, pancreas and stomach.
Biomarker: A measurable indicator—such as a protein, nucleic acid or metabolite—reflecting graft health, injury or rejection state.
References
- Intestinal Transplant Immunology and Intestinal Graft Rejection: From Basic Mechanisms to Potential Biomarkers. International Journal of Molecular Sciences (2023).
- Multivisceral Transplantation for Diffuse Portomesenteric Thrombosis: Lessons Learned for Surgical Optimization. Frontiers in Surgery (2021).
- Innovations in Immunosuppression for Intestinal Transplantation. Frontiers in Nutrition (2022).
- Biologicals in the prevention and treatment of intestinal graft rejection: The state of the art Biologicals in Intestinal Transplantation. Human Immunology (2024).
- First report of full colon transplantation as part of a visceral allograft. Techniques in Coloproctology (2025).
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