Rong Y, Nie CY, Zhou JD, Wang ZC, Wu DL, Wu SW, Xie ZY. Intestinal reengineering: Scientific advances in intestinal transplantation. World J Gastrointest Surg 2025; 17(10): 111672 [DOI: 10.4240/wjgs.v17.i10.111672]
Corresponding Author of This Article
Zheng-Yong Xie, Chief Physician, Professor, Department of General Surgery, The General Hospital of Southern Theater Command, No. 111 Liuhua Road, Yuexiu District, Guangzhou 510000, Guangdong Province, China. pwkxiezy@163.com
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Surgery
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Review
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Oct 27, 2025 (publication date) through Oct 24, 2025
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Publication Name
World Journal of Gastrointestinal Surgery
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1948-9366
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Rong Y, Nie CY, Zhou JD, Wang ZC, Wu DL, Wu SW, Xie ZY. Intestinal reengineering: Scientific advances in intestinal transplantation. World J Gastrointest Surg 2025; 17(10): 111672 [DOI: 10.4240/wjgs.v17.i10.111672]
World J Gastrointest Surg. Oct 27, 2025; 17(10): 111672 Published online Oct 27, 2025. doi: 10.4240/wjgs.v17.i10.111672
Intestinal reengineering: Scientific advances in intestinal transplantation
Yao Rong, Chen-Yang Nie, Ji-Dian Zhou, Zi-Cheng Wang, Di-Lin Wu, Sheng-Wei Wu, Zheng-Yong Xie
Yao Rong, Ji-Dian Zhou, Zi-Cheng Wang, Di-Lin Wu, Sheng-Wei Wu, Zheng-Yong Xie, Department of General Surgery, The General Hospital of Southern Theater Command, Guangzhou 510000, Guangdong Province, China
Chen-Yang Nie, Department of Quality Management, The General Hospital of Southern Theater Command, Guangzhou 510000, Guangdong Province, China
Co-first authors: Yao Rong and Chen-Yang Nie.
Co-corresponding authors: Sheng-Wei Wu and Zheng-Yong Xie.
Author contributions: Author contributions: Rong Y, Nie CY and Xie ZY conceived the study; Zhou JD collected the relevant data; Wang ZC and Wu DL created the figures and tables; Rong Y wrote a draft; Wu SW and Xie ZY reviewed and revised the manuscript; Rong Y and Nie CY contributed equally to this work; Xie ZY and Wu SW are co-corresponding authors; All authors read and approved the final manuscript. Both Wu SW and Xie ZY have played critical and indispensable roles as the co-corresponding authors. Wu SW was instrumental in the critical revision of the manuscript for important intellectual content, provided expert guidance on surgical and technical aspects of intestinal transplantation, and supervised the integration of clinical data. Xie ZY conceptualized and designed the research, secured funding, provided overall supervision of the project, and was responsible for the final approval of the manuscript version to be published. Their collaborative leadership was essential to the completion and refinement of this review.
Supported by Guangdong Provincial Medical Research Fund General Program, No. B2025209; and Guangzhou Science and Technology Program Project, No. 2025A03J3269.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zheng-Yong Xie, Chief Physician, Professor, Department of General Surgery, The General Hospital of Southern Theater Command, No. 111 Liuhua Road, Yuexiu District, Guangzhou 510000, Guangdong Province, China. pwkxiezy@163.com
Received: July 6, 2025 Revised: July 20, 2025 Accepted: September 2, 2025 Published online: October 27, 2025 Processing time: 110 Days and 16.5 Hours
Abstract
Intestinal transplantation (ITx) has emerged as a pivotal life-saving intervention for patients with irreversible intestinal failure unresponsive to conventional medical and nutritional therapies. Despite its growing clinical acceptance, ITx remains among the most immunologically complex and technically demanding procedures in the field of solid organ transplantation. This review comprehensively summarizes the historical evolution, clinical indications, and advancements in surgical techniques, with emphasis on innovations in vascular anastomosis, multivisceral transplantation, and ex vivo preservation. Special attention is given to the unique immunological challenges of ITx, including bidirectional immune responses-host-vs-graft and graft-vs-host disease-immune-microbiota interactions, and the distinct roles of key immune cells. Pediatric and adult recipients exhibit divergent etiologies, immune responses, and complication profiles, necessitating individualized approaches. Although novel immunotherapeutic strategies and bioengineering innovations have improved short-term outcomes, chronic rejection, graft dysfunction, and immunosuppressive toxicity remain significant barriers. Looking ahead, future directions should prioritize precision immunomodulation, microbiome-targeted therapies, and integrated platforms for gene editing, 3D bioprinting, and immune monitoring. Through multidisciplinary collaboration and translational research, ITx is poised to evolve from a high-risk salvage therapy into a personalized, sustainable solution that enhances long-term survival and patient quality of life.
Core Tip: This review systematically elucidates the current status and challenges of intestinal transplantation (ITx) as a life-saving therapy for patients with irreversible intestinal failure. Despite therapeutic hurdles such as the high immunogenicity of the intestine, complex microbiota microenvironment, and susceptibility to rejection, surgical innovations-including robot-assisted vascular anastomosis and multivisceral transplantation-along with breakthroughs in ex vivo perfusion technology have significantly improved clinical outcomes. This review highlights that bidirectional immune reactions (host-vs-graft response and graft-vs-host disease) and chronic rejection remain the primary clinical obstacles. Analysis herein reveals marked differences in immunological profiles and clinical manifestations between pediatric and adult recipients, necessitating individualized treatment strategies. Based on current research advances, future directions include precision immunotherapy, gut microbiota modulation, and bioengineering innovations such as 3D bioprinted grafts. The review emphasizes that only through multidisciplinary collaboration can ITx evolve into a safer and more effective treatment, ultimately achieving comprehensive improvements in long-term survival rates and quality of life for patients.
