Small Bowel Transplantation

swing over the last five years thanks to the remarkable improvement of its outcome. This has been due mainly to the improvement of immunosuppressive protocols. The pioneers in SBT using animal models include Alex Carrel (1902, first transplantation of an intestinal segment in the dog) (1), Lillehei (1955, first orthotopic SBT in the dog) (2), and Monchik and Russel (1971, first model of SBT in the rat) (3). Initial clinical experiments (4) were doomed to failure because of inadequate immunosuppressive therapy was used. Renewed interest in SBT in the 1980s came with the introduction of cyclosporin into immunosuppressive protocols. However, appreciable improvement of outcomes did not come until ten years later with the advent of tacrolimus. The initially disappointing results were associated with the specific properties of the small bowel in contrast of other solid transplants. The small bowel is the largest immunological organ with a vast number of immunocompetent cells. It is the only organ used for transplantation which is not sterile, which has a complex dense intramural nervous network and, last but not least, which does not have a simple clinical test to determine bowel graft function and to monitor rejection the way it is with the other solid transplants (creatinine with the kidney, transaminases and bilirubin with the liver) (5).