Prasad K R, Pollard S G
Department of Organ Transplantation, St. James's University Hospital, Leeds, United Kingdom.
Curr Opin Gastroenterol. 2000 Mar;16(2):126-33. doi: 10.1097/00001574-200003000-00006.
The development of small bowel transplantation has long been hindered by the immunological and infectious barriers peculiar to the small bowel. Gradual progress has been achieved during the past decade with the use of tacrolimus and the availability of better anti-infection prophylaxis. The current status of small bowel transplantation as a life-saving option for patients failing on total parenteral nutrition and those who have developed irreversible liver failure is undisputed. Small bowel transplantation can be performed as either an intestine-only graft or as part of a composite graft with the liver and, on occasion, other organs. The various techniques of donor and recipient operations are relatively standardized. Despite the progress made, the most common causes of death and graft loss continue to be sepsis, rejection, and lymphomas. Further progress can be achieved by development of more effective immunosuppressive and immunomodulatory strategies. The role of inducing chimerism by adjuvant donor-specific bone marrow transfusions to promote graft tolerance is uncertain. Until the mortality and graft losses are further reduced, the role of small bowel transplantation will be limited to a salvage procedure for failure of total parenteral nutrition rather than a primary treatment of intestinal failure.
小肠移植的发展长期以来一直受到小肠特有的免疫和感染屏障的阻碍。在过去十年中，随着他克莫司的使用以及更好的抗感染预防措施的出现，已经取得了逐步进展。小肠移植作为全肠外营养失败患者以及出现不可逆肝功能衰竭患者的一种挽救生命的选择，其现状是无可争议的。小肠移植既可以作为单纯的肠移植进行，也可以作为与肝脏以及偶尔与其他器官组成的复合移植的一部分进行。供体和受体手术的各种技术相对标准化。尽管取得了进展，但死亡和移植物丢失的最常见原因仍然是败血症、排斥反应和淋巴瘤。通过开发更有效的免疫抑制和免疫调节策略可以取得进一步进展。通过辅助性供体特异性骨髓输注诱导嵌合体以促进移植物耐受的作用尚不确定。在死亡率和移植物丢失进一步降低之前，小肠移植的作用将仅限于作为全肠外营养失败的挽救性手术，而不是肠道衰竭的主要治疗方法。
