| Autor: |
Meira Filho SP; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Guardia BD; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Evangelista AS; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Matielo CE; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Neves DB; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Pandullo FL; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Felga GE; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Alves JA; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Curvelo LA; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Diaz LG; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Rusi MB; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Viveiros Mde M; Hospital Santa Marcelina, São Paulo, SP, Brazil., Almeida MD; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Epstein MG; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Pedroso PT; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Salvalaggio P; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Meirelles Júnior RF; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Rocco RA; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Almeida SS; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Rezende MB; Hospital Santa Marcelina, São Paulo, SP, Brazil. |
| Abstrakt: |
Intestinal transplantation has shown exceptional growth over the past 10 years. At the end of the 1990's, intestinal transplantation moved out of the experimental realm to become a routine practice in treating patients with severe complications related to total parenteral nutrition and intestinal failure. In the last years, several centers reported an increasing improvement in survival outcomes (about 80%), during the first 12 months after surgery, but long-term survival is still a challenge. Several advances led to clinical application of transplants. Immunosuppression involved in intestinal and multivisceral transplantation was the biggest gain for this procedure in the past decade due to tacrolimus, and new inducing drugs, mono- and polyclonal anti-lymphocyte antibodies. Despite the advancement of rigid immunosuppression protocols, rejection is still very frequent in the first 12 months, and can result in long-term graft loss. The future of intestinal transplantation and multivisceral transplantation appears promising. The major challenge is early recognition of acute rejection in order to prevent graft loss, opportunistic infections associated to complications, post-transplant lymphoproliferative disease and graft versus host disease; and consequently, improve results in the long run. |
