History of Intestinal Transplant
Bowel transplantation was first attempted in humans during the 1960s. At that time, patients were dying of starvation after having a large portion of their bowel removed because of disease or trauma. Parenteral (intravenous) feeding was not yet available, and surgeons hoped that the transplanted bowel would function normally. These first intestinal transplant patients died, however, from technical complications, rejection, or infection. Successful intestinal transplants were not performed until the early-1980s. Most grafts during this era were lost to technical problems and rejection. Following the introduction of tacrolimus Prograf® (FK506, tacrolimus) (in 1994 based on the studies done in Pittsburgh, there was a demonstrable drop in rejection leading to improvement in graft and patient survival. For patients transplanted at centres of excellence the actuarial overall patient survival rate now is 93% at 1 year, 70% at 5 years and 50% at 10 years.
As of June 2013, there have been 2584 reported cases of intestinal transplantation in 2398 patients as reported in International Transplant Registry. 70% of patients have been successfully weaned off parenteral nutrition and are on a normal diet, enjoying a healthy lifestyle after intestinal transplantation . Several technological advances have led to modification of operative techniques in the donor and recipient leading to reduction in operating time, better preservation of allograft and implementation of novel techniques. Introduction of newer immunosuppressive strategies have led to significant improvement in 1, 5 and 10 year graft and patient survival rates. Good outcomes have also prompted surgeons to offer re-transplantation in selected cases leading to improved quality of life and prevent patient death.