Darmtransplantatie: van een experimentele procedure tot een levensreddende behandelingsoptie voor patiënten met gecompliceerd darmfalen

Abstract

Bowel transplantation: from an experimental procedure to a life-saving treatment option for patients with complicated bowel failure Intestinal transplantation is the rarest form of solid organ transplantation, probably due to the important immunobiological challenges linked to the procedure, resulting in the need for high levels of immunosuppression and in life-threatening complications like infections, malignancies and renal failure. These factors explain the poor long-term results after small bowel transplantation and the fact that this procedure has always been reserved as the sole life-saving option for patients with severely complicated intestinal failure due to loss of vascular access, infections, or liver failure induced by total parenteral nutrition. In the last decade, an improvement in patient survival and prevention of rejection is observed. This is the result of a better understanding of the immune response and the development of immunomodulatory protocols, like the Leuven protocol, that aims to lower the level of immunosuppression. This review summarizes the current experience and the most recent evolutions in the field of bowel transplantation, describes the Leuven and the Belgian results and compares them to the international data.