Mäkisalo H, Ericzon B G
Department of Surgery, Helsinki University Central Hospital, Finland.
Ann Chir Gynaecol. 1997;86(2):155-62.
In contrast to other solid organ transplantations slow progress has been seen in introducing intestinal transplantation (IT) from an experimental level to clinical practice. In nine years less than 200 transplantations have been performed worldwide with a three-years, survival of approximately 40%. The main problem of IT is immunological. Large amounts of lymphatic tissues transplanted along with the intestinal graft increase the risk of acute rejection and necessitate high doses of immunosuppressive regimens liable of inducing serious side-effects. The immunocompromized recipient is vulnerable to various infections, particularly cytomegalovirus (CMV) enteritis of the graft. However, improved results are expected after introducing modern potent immunosuppressive drugs such as combination of tacrolimus and mycophenolic acid. Emphasized antiviral prophylaxis and treatment, improved preservation and prevention of ischaemia reperfusion injury are other means presently available to obtain better results after intestinal transplantation in the near future. Intestinal transplantation is becoming the treatment of choice in intestinal failure when total parenteral nutrition (TPN) fails for one reason or an other.
与其他实体器官移植相比，肠道移植（IT）从实验阶段引入临床实践的进展较为缓慢。在九年时间里，全球范围内进行的移植手术不到200例，三年生存率约为40%。IT的主要问题是免疫方面的。与肠道移植物一起移植的大量淋巴组织增加了急性排斥反应的风险，并且需要高剂量的免疫抑制方案，而这些方案容易引发严重的副作用。免疫功能低下的受者易受各种感染，尤其是移植肠道的巨细胞病毒（CMV）肠炎。然而，在引入现代强效免疫抑制药物（如他克莫司和霉酚酸联合使用）后，预计会有更好的结果。强调抗病毒预防和治疗、改进保存方法以及预防缺血再灌注损伤是目前在不久的将来肠道移植后获得更好结果的其他可用手段。当全肠外营养（TPN）因某种原因失败时，肠道移植正成为肠道衰竭的首选治疗方法。
