Intestinal and Multivisceral Transplantation: Recent Advances

Continuous progress has been made over the last few decades in the management of children with intestinal failure. Significant advances include gut rehabilitation, autologous reconstruction, bowel lengthening, and visceral transplantation. Gut replacement is one of the most important milestones in the recent history of organ transplantation. Improved donor management, refinement of surgical techniques, introduction of new immunosuppressive protocols, and improved follow-up care have led to increased survival. As a result, intestinal and multivisceral transplantation is now an established treatment option for these unique patients. Congenital diarrhea disorders have been better characterized recently with the potential to further expand the indications for intestinal transplantation. From the immunological standpoint, the impact of donor-specific antibodies (DSAs) on posttransplant outcomes has received increased attention and stimulated the modification of the immunosuppression protocols. With the increasing number of patients surviving gut transplantation, quality of life has become an important aspect of the outcome measures after transplantation. In this chapter we describe recent advances in gut rehabilitation and visceral transplantation with special emphasis on newly characterized congenital disorders requiring transplantation, the evolving role of DSA, and the current long-term outcomes, including quality of life.