Analysis of the Clinical Era of the Intestinal and Multivisceral Transplantation

Abstract

Introduction: Nowadays, there has been an increase in the casuistic of intestinal and multivisceral transplant. Surgical technical improvements, close post transplant follow-up and better understanding of the intestinal immunology are the main reasons for this classic experimental research to the clinical practice. Furthermore, there is an improvement in the immunosuppressant therapy, in the graft rejection diagnosis, in the post-transplant linfoproliferative disease therapy and in viral infection monitoring and treatment. The post-extensive intestinal resection short gut Syndrome with later very poor absorption of water and nutrients is the classic indication to intestinal transplant. Children’s major indications are: gastroschise (21%), volvulus (18%) and necrotizing enterocolitis (12%). The adult’s are: vascular diseases such as ischemic or hemorrhagic mesenteric stroke (22%), Crohn disease (13%) and trauma (12%). Parenteral nutrition is the life support for suxh sicknesses, but with serious complications such as deep vascular access thrombosis and catheter infection. Purpose: to analyze the characteristics and results for the intestinal and multivisceral transplant in the clinical era. Methods: Extensive literature review of articles indexed in Medline and Lilacs until January, 2009. Results: In the past 20 years, the results of the intestine and multivisceral transplantation have shown a progressive survival improvement at one year both for patients and grafts, attaining success rates of up to 80%. Acute cellular rejection of intestinal grafts occurred more frequently and with greater severity when compared to any other abdominal organ. There was a significant decrease in the incidence of severe rejection upon the use of multivisceral graft, particularly in children, and the use of the therapy to induce the immunosuppression has contributed to a decrease in the rejection rates. The major causes of death in the early or late intestine transplantation were sepsis and rejection. Conclusions: In Brazil, the development of the intestine transplantation should occur, having as a goal to achieve the same results attained in international centers, a reality already attained by other modalities of transplantation in Brazil.