Introduction

In 1959, Richard Lillehei et al. were the first to describe the autologous intestinal transplantation of the entire small intestine in dogs (Lillehei et al. 1959). The transplanted bowel had an indefinite survival. One year later Starzl and Kaupp successfully transplanted multiple viscera including small bowel in dogs. The surgical techniques originally described by Starzl are employed to this day (Kocoshis 1994).

In the 1960s and 1970s, several reports of human multi-organ transplantation and intestinal transplants were published, but the immunosuppressants used at that time, consisting of prednisone and azathioprine, did not confer sufficient protection against rejection (Grant 1989). The patients did not survive longer than a few weeks. These results were so devastating that intestinal transplantation was discontinued. It was not until the discovery of cyclosporin that attempts at intestinal transplantation were resumed. The introduction of OKT3 and the use of irradiation of the graft yielded encouraging results. In a small series of four intestinal-transplant patients, two of them survived 109 and 165 days. Both of them died as a result of developing lymphoproliferative disorder but not as a result of rejection. With the appearance of newer immunosuppressants like FK506, survival significantly improved, resulting in increased implementation of this potentially life-saving procedure.

From 1990 to 1994, the group at the Children's Hospital at Pittsburgh operated on more than 50 patients of which 32 were children, ranging in age from 6 months to 15 years (Kocoshis 1994). Twenty patients had combined liver and intestinal transplants.