Artificial intelligence in anaesthesiology: why don't we have it in our hands after a decade of innovation? A systematic review and perspective.

Intestinal transplantation represents the definitive therapeutic option for short bowel syndrome, intestinal failure, and certain complex abdominal conditions such as extensive mesenteric ischemia and abdominal desmoid tumors. Compared with solid organ transplantation of the liver or kidney, intestinal transplantation involves multi-visceral abdominal clusters, abundant lymphoid tissue, and extreme susceptibility of the graft to ischemia-reperfusion injury (IRI), rendering perioperative management uniquely challenging. According to data from the Organ Procurement and Transplantation Network (OPTN), fewer than one hundred intestinal transplant procedures are performed annually in the United States, and fewer than five peer-reviewed publications directly addressing intestinal transplantation anesthesia each year. This statistic reflects both the specialized nature and rarity of the field while highlighting the necessity of systematically synthesizing recent publications to guide clinical practice. It is important to distinguish between isolated intestinal transplantation and multivisceral transplantation (which includes the liver). In isolated intestinal transplantation, there is no anhepatic phase; the surgical procedure involves clamping of the superior mesenteric vessels only. In contrast, multivisceral transplantation (including liver-intestine or full multivisceral grafts) involves clamping of the portal vein and hepatic artery, creating a true anhepatic phase. This distinction has major implications for hemodynamic management, coagulation, and metabolic monitoring, as discussed in later sections (Fig. ).