Small Intestine Transplantation: A Comprehensive Analysis of the Morphological and Physiological Alterations in Graft Motility Following Transplantation

Small intestine transplantation is a complex operation used for conditions such as short bowel syndrome, Crohn’s disease, intestinal motility disorders, birth defects, and tumors. This work analyzes the morphological and physiological changes that occur during transplantation, with an emphasis on restoring peristalsis, and comprehensively examines the mechanisms of restoring peristalsis after small intestine transplantation, an important procedure for patients with irreversible intestinal insufficiency. Historical aspects, types of intestinal motility, and regulatory systems are studied, including neural, hormonal, and cellular pathways (e.g., interstitial cells of Cajal). Particular attention is paid to graft-specific changes, including extrinsic denervation and reinnervation, ischemia–reperfusion injury, alterations of interstitial cells of Cajal and smooth muscle, and rejection, with a distinction between experimental and clinical evidence. Postoperative management strategies, assessment methods, and factors affecting motor recovery are analyzed, with an emphasis on the interaction of surgical techniques, immunosuppressive therapy, and nutritional support. Treatment approaches and possible complications affecting the outcome of the procedure are also discussed. The results highlight progress in understanding peristalsis regulation, suggesting new approaches to improve transplant outcomes and patient quality of life.