Small bowel transplantation: current achievements and challenges

Introduction. Over the past five years, small bowel transplantation (SBT) has undergone significant changes, evolving from an experimental procedure into a life-saving standard of care for patients with irreversible chronic intestinal failure. Analysis of data from the International Intestinal Transplant Registry (IITR) confirms a gradual decline in the number of procedures performed, attributable to improvements in alternative treatment modalities. Nevertheless, SBT remains the only chance for survival in patients with life-threatening complications of parenteral nutrition.

Objective. The aim of this review is to summarize current knowledge and describe the present status of small bowel transplantation. Specifically, the review covers key aspects of modern SBT, including epidemiology, diagnostic criteria, indications for transplantation, immunosuppression regimens, and potential complications. Particular attention is paid to improved survival outcomes, persistent challenges related to chronic rejection, as well as novel approaches and emerging directions in the field.

Material and methods. The review is based on an analysis of scientific literature published between 2010 and 2025, including clinical guidelines, meta-analyses, randomized controlled trials, and major registry datasets. Both international and Russian publications were taken into account.

Conclusion. Clinical small bowel transplantation remains a complex and evolving field of medicine. Ongoing research and technological advances will continue to shape its future. Significant progress has already been achieved in both conservative and surgical management of transplant recipients. Survival rates are now comparable to those observed with long-term home parenteral nutrition; therefore, intestinal transplantation should be considered for all patients with irreversible intestinal failure.

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