Small intestine transplantation is one of possible therapeutic methods for patients with intestinal failure.
The most common causes of intestinal failure include: vascular catastrophes, abdominal trauma, Crohn’s disease, post-radiation enteritis and consequences of abdominal post-operative complications. Gastroschisis, intestinal atresia, necrotising enterocolitis, volvulus and malrotation are the prevailing causes in children. Functional intestinal disorders, such as chronic intestinal pseudo-obstruction and Hirschprung’s disease, are rather rare causes. Among cancerous diseases, desmoid tumours are a cause, often forming part of the Gardner syndrome. The indication criteria are not strictly determined. They include life-threatening complications of parenteral nutrition (relapsing catheter infections, loss of more than two main venous access points, liver damage) and excessive losses of fluids and minerals. Small intestine transplantation is associated not only with the complexity of the surgery in patients after many previous interventions and with high demands for the quality of vascular and digestive anastomoses, but also with the need of managing subsequent immune reactions given by the transfer of a large volume of lymphatic tissue.
At IKEM, the first multivisceral transplantation was performed in December 2014, in a patient with the diagnosis of multivisceral thrombosis and autoimmune liver cirrhosis.