History

Transplantation of vascularized organs, such as the intestine, was first conceptualized by Alexis Carrel at the turn of the century, who recognized the potential for such procedures with the establishment of a reliable method of performing vascular anastomoses.1 However, the feasibility of intestinal transplantation was not demonstrated until 1959 when Richard Lillihei, at the University of Minnesota, reported success in a canine model.2 This inspired the first human intestinal transplants, which were performed by Ralph Deterling in Boston in 1964 (unpublished). The first reported human intestinal transplant was performed by Lillihei in 1967, and included the entire small bowel and right colon, with the superior mesenteric vessels being anastomosed to the left common iliac vessels.3 Unfortunately, these and other early attempts which followed were uniformly unsuccessful.4

When the effectiveness of cyclosporine was established in other organ transplants in the early 1980's, there was renewed interest in intestinal transplantation. Although the first intestinal transplant using cyclosporine, performed in 1985 by Zane Cohen in Toronto5 was also unsuccessful, in 1988 Deltz in Kiel, Germany performed what is considered to be the first successful intestinal transplant.6 The recipient of this living-related allograft remained TPN-free for 4 year before the graft was lost to chronic rejection. Soon after, other successful outcomes were reported by the groups headed by Goulet in Paris,7 and Grant in London, Canada8 who had established the first intestinal transplant programs. The successes of these groups inspired other institutions to establish similar programs in the early 1990's.9 There are now over 50 centers worldwide which have performed intestinal transplants, with close to 700 transplants performed to date.10

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