Small Bowel Transplantation: An Overview

Small bowel transplant is the most effective salvage procedure for intestinal failure occurring due to various causes. The isolated small bowel graft comprises the entire length of the jejunum and ileum based on the SMA and SMV. In the recipient, the GI continuity is established by jejuno-jejunostomy proximally; the distal bowel is brought out as a Bishop-Koop ileostomy, loop, or end ileostomy. In multivisceral transplant, the liver, along with intact hilar structures, the small bowel, and the pancreas allograft, is harvested en bloc. Segment of the aorta in continuity to the CA and SMA is used for the arterial supply. The venous drainage is connected to the hepatic veins/donor vena cava. For immunosuppression, induction agents, such as Basiliximab, Lemtuzumab, or Rituximab, are used for T-cell depletion, administered before the transplant if possible, along with steroids on the day of surgery. Afterwards, Tacrolimus and Mycophenolate mofetil (MMF) are started on POD 1 and adjusted as needed. Rejection, acute or chronic, is the most common postoperative complication.