Improved anti-rejection drugs, refined surgical procedures, and a greater understanding of immunology have contributed to successful intestinal transplants. Short-term survival is now comparable to lung transplantation results. Most of the patients in the international Intestinal Transplant Registry have been followed for a brief time; it will take several years to obtain reliable data on long-term results.
Until a few years ago, Sandimmune® (cyclosporine) was used most often to prevent organ rejection. Prograf® (tacrolimus) has been given to most intestinal transplant patients over the past 4 years. As of May 2007, 45% of all intestinal patients had died, usually from sepsis, multiple organ system failure or rejection. Of the surviving patients, three-fourth had stopped total parenteral nutrition (TPN) and had resumed a normal, oral diet.
To become the standard treatment for intestinal failure, transplantation must offer better survival, better quality of life, and lower costs than TPN. Considerable progress has been made towards these goals, but further refinements are needed before bowel transplantation becomes a routine surgical procedure.