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Intestinal and multivisceral transplantation

机译：肠道和多脏器移植

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Intestinal transplantation has shown exceptional growth over the past 10 years. At the end of the 1990’s, intestinal transplantation moved out of the experimental realm to become a routine practice in treating patients with severe complications related to total parenteral nutrition and intestinal failure. In the last years, several centers reported an increasing improvement in survival outcomes (about 80%), during the first 12 months after surgery, but long-term survival is still a challenge. Several advances led to clinical application of transplants. Immunosuppression involved in intestinal and multivisceral transplantation was the biggest gain for this procedure in the past decade due to tacrolimus, and new inducing drugs, mono- and polyclonal anti-lymphocyte antibodies. Despite the advancement of rigid immunosuppression protocols, rejection is still very frequent in the first 12 months, and can result in long-term graft loss. The future of intestinal transplantation and multivisceral transplantation appears promising. The major challenge is early recognition of acute rejection in order to prevent graft loss, opportunistic infections associated to complications, post-transplant lymphoproliferative disease and graft versus host disease; and consequently, improve results in the long run.
机译：在过去的10年中，肠移植已显示出异常的增长。在1990年代末，肠道移植已经脱离了实验领域，成为治疗与完全胃肠外营养和肠道衰竭有关的严重并发症的患者的常规做法。在过去的几年中，几个中心报告说，在手术后的最初12个月中，生存结果的改善有所提高（约80％），但是长期生存仍然是一个挑战。几项进展导致了移植物的临床应用。在过去的十年中，由于他克莫司以及新的诱导药物，单克隆和多克隆抗淋巴细胞抗体，涉及肠和多脏器移植的免疫抑制是该手术的最大收益。尽管刚性免疫抑制方案有所进展，但排斥反应在开始的头12​​个月仍然非常频繁，并可能导致长期的移植物丢失。肠移植和多脏器移植的未来似乎很有希望。主要挑战是及早认识到急性排斥反应，以防止移植物丢失，与并发症相关的机会性感染，移植后的淋巴增生性疾病以及移植物抗宿主病。因此，从长远来看，可以改善结果。

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