Introduction

Visceral transplantation is the accepted standard of care for patients in end-stage organ failure. It is well established in kidney, liver, and cardiac failure. Recently pancreas and lung transplantation have also become routine, although infrequently performed in the pediatric population. Although one of the first organs to be transplanted as an en-bloc procedure with the liver, the intestine has been a notoriously difficult organ to successfully transplant. Early results were universally poor, and it wasn't until the development and use of tacrolimus in 1990 that the procedure could be performed with reasonable expectation of success. Even so, initial outcomes were marginal with many programs performing only a handful of cases before terminating their experience. A few centers persevered, and with ongoing experience and continued development have greatly advanced the field. It has evolved in every aspect, technically and medically, but this is true in particular with respect to advances in immunosuppression protocols. Currently, the outcomes are approaching that achieved in other types of organ transplantation, and it has become the accepted standard of care for patients with irreversible intestinal failure who are failing parenteral nutrition.

Historical perspective

Clinical organ transplantation dates back to 1960 with the first successful kidney transplantation. Successes followed in liver, pancreas, heart and lung. On the contrary, the early experience with intestinal transplantation, either alone or with other organ combinations, both in humans and research animals, was universally poor. Even into the 1980s, successful human intestinal transplantation was rare and mostly short lived.