INTESTINE TRANSPLANTATION

Intestinal transplantation is performed much less frequently than transplantation of other solid organs. In 2001, 111 intestinal transplants were performed in the United States, and there were approximately 180 patients on the waiting list. Short-gut syndrome accounted for more than 60% of these transplants, and half the recipients were younger than 6 years.^[156]

The overall graft survival rate at 1 and 5 years was 66% and 20%, respectively. These outcomes are markedly improved in comparison to earlier years, when early universal graft failure was very common. Changes in immunosuppressive therapy are thought to be responsible for the improved graft survival.^[282] Only a few centers perform this procedure as either an isolated intestinal transplantation or a combined liver-intestinal transplantation. Dependence on total parenteral nutrition can lead to steatotic liver disease with hepatic failure requiring combined liver-intestinal transplantation. Optimization of hepatosplanchnic blood flow is essential for these cases. Fluid loading and inotropic support may be beneficial.^[283] However, no studies have investigated the perioperative anesthetic management and graft/patient outcome.