The intestine is the lower part of the digestive tract, extending from the stomach to the anus.
It provides further digestion of food and absorbs nutrients from the digested food.
The lower part, the large intestine, is wider and reabsorbs water from the digested foods and sends it back into the bloodstream.
In a small bowel transplant, the diseased portion of the small intestine is removed and replaced with a healthy small intestine from a donor.
Who needs a transplant?
The loss of absorptive capacity of the small intestine can result in intestinal failure. There are different reasons for intestinal failure.
Total Parenteral nutrition induced liver failure
Short bowel syndrome post removal of a part of the small intestine
Congenital short gut syndrome in infants
Abdominal trauma
Crohn’s disease
Clotting of the blood vessels to the small bowel
Surgical adhesions
Surgical Resection of the intestine
Congenital anomalies
Necrotizing Enterocolitis
Enterocyte disorders such as microvillous disease or Tufting enteropathy
Tumor
Volvulus
Pre - Transplant Evaluation
An intestinal transplant evaluation usually requires up to two weeks of outpatient testing.
Waiting for a donor could be a long process as this procedure mostly needs compatible organs from a deceased donor.
Once the organ is available the patient undergoes preoperative assessments.
The preoperative testing consists of a Chest X-ray, EKG and comprehensive lab work.
Surgery
Although it is possible for a living donor to donate an intestine segment, most intestine transplants involve a whole organ from a deceased donor. Intestinal transplants is a very challenging procedure. It is the least frequently performed vascularized intra abdominal organ transplants.
Small intestinal transplant can be of different types.
Intestine only
Modified multivisceral transplant including all organs except the liver
Full multivisceral transplant including the stomach, duodenum, pancreas, intestine and liver
Combined liver and intestine with pancreas transplant.
Postoperative Care
A temporary stoma (for 6-12 months) is a surgically-created opening in the small bowel or colon (respectively ileostomy and colostomy) that allows the transplant team to monitor the transplanted organ.
There might be a need for an additional feeding tube from the skin to the GI tract in some cases.
The post-operative care involves 2-4 days of intensive care stay.
Comprehensive post-surgical monitoring constantly evaluates whether the body is accepting the new organ.
In addition, the amount of time you spend in the recovery room, waking up and getting to the point that you’re ready to go home, will vary from patient to patient.
Living with a Transplant
During the first 4-6 months post transplant the transplant team will closely monitor you for any signs of organ rejection with blood work, ultrasounds, endoscopies and biopsies as needed.
There might be restrictions on diet and daily activities depending on the transplant.
There might be additional care needed for the stoma and the feeding tube if present.
Transplant patients will be continued to be monitored for life time however, the intensity of the tests might reduce after a year post transplant.
