Potential options to expand the intestinal donor pool: a comprehensive review

Abstract

Purpose of reviewIntestinal donation is currently restricted to ‘perfect’ donors, as the intestine is extremely vulnerable to ischemia. With generally deteriorating donor quality and increasing indications for intestinal transplantation (ITx), the potential to safely increase the donor pool should be evaluated.Recent findingsIncreasing awareness on intestinal donation (often forgotten) and cautiously broadening the strict donor criteria (increasing age, resuscitation time and ICU stay) could expand the potential donor pool. Donors after circulatory death (DCD) have so far not been considered for ITx, due to the particularly detrimental effect of warm ischemia on the intestine. However, normothermic regional perfusion might be a well tolerated strategy to render the use of DCD intestinal grafts feasible. Furthermore, machine perfusion is under continuous development and might improve preservation of the intestine and potentially offer a platform to modulate the intestinal graft. Lastly, living donation currently represents only a minority of all ITxs performed worldwide. Various studies and registry analysis show that it can be performed safely for the donor and successfully in the recipient.SummarySeveral potential strategies are available to expand the current intestinal donor pool. Most of them require further investigation or technical developments before they can be implemented in the clinical routine.

Outcome after Intestinal Transplantation from Living versus Deceased Donors

“…41,42 There have been no reported deaths or major complications. [43][44][45][46][47][48] Wu et al reported in 40 donors 1 intraoperative bleeding, 1 small bowel obstruction (conservatively treated), and 1 incisional hernia. 48 Donor´s weight decreased during the first months postoperatively, but was restored at 1 year.…”

Living Donor Intestinal Transplantation

“…According to recent data from the International Intestinal Transplant Registry (ITR), only 78 (1.9%) out of 4156 patients transplanted up to September 2019 worldwide have been reported as living donors. 6 Despite potential risks to the donor, living-organ donation can offer substantial advantages over the deceased donation, particularly in terms of the elective nature of the procedure, better HLA matching, shorter cold ischemia times, and reduced waiting times. Moreover, the use of living donors can provide greater opportunity to implement desensitization protocols in the setting of highly sensitized ITx candidates.…”

“…The published results of retrospective case reports and case series are limited by the small numbers of patients, study methods, and a lack of donor and recipient long-term outcomes. 6 , 10 Although preliminary outcomes appear encouraging, the role of LDITx has not yet been established. From 1999 to 2021, our team has performed 40 LDITx procedures and hereby we report our short-term and intermediate-term clinical outcomes of recipients after this procedure.…”

“…Unlike kidney and liver transplantation, the use of living donation for intestinal transplantation (ITx) has been limited as the deceased donor supply largely exceeds the current demand. According to recent data from the International Intestinal Transplant Registry (ITR), only 78 (1.9%) out of 4156 patients transplanted up to September 2019 worldwide have been reported as living donors 6. Despite potential risks to the donor, living-organ donation can offer substantial advantages over the deceased donation, particularly in terms of the elective nature of the procedure, better HLA matching, shorter cold ischemia times, and reduced waiting times.…”

“…To date, there is a paucity of data regarding the safety and effectiveness of LDITx. The published results of retrospective case reports and case series are limited by the small numbers of patients, study methods, and a lack of donor and recipient long-term outcomes 6,10. Although preliminary outcomes appear encouraging, the role of LDITx has not yet been established.…”