Our Summary

This research paper discusses the changes and advancements in adult intestinal transplantation over the past two decades. The reasons for conducting this kind of surgery have expanded to include motility disorders and desmoid tumors. The type of graft used in the surgery depends on the specific anatomy of the adult patient.

In the past, including the colon in the transplant was thought to lead to unfavorable outcomes due to the complex interactions between the host and bacteria. However, more recent findings show that including the colon has actually led to better survival rates for the graft and improved the patient’s quality of life.

The overall results of adult intestinal transplants have been improving steadily. The paper concludes that these transplants remain a crucial treatment for severe intestinal failure and offer a hopeful option for other serious and debilitating conditions.

FAQs

  1. How does adult intestinal transplantation differ from pediatric intestinal transplantation?
  2. What are the expanded indications for adult intestinal transplantation over the last two decades?
  3. Has the overall outcome of adult intestinal transplantation improved over time?

Doctor’s Tip

One helpful tip a doctor might tell a patient about intestinal transplant is to follow a strict post-transplant medication regimen to prevent rejection of the new intestine. This may include immunosuppressive medications and antibiotics to prevent infections. It is important to take these medications exactly as prescribed to ensure the success of the transplant. Additionally, maintaining a healthy lifestyle with a balanced diet, regular exercise, and avoiding smoking and excessive alcohol consumption can also contribute to the long-term success of the transplant. Regular follow-up appointments with your transplant team are essential for monitoring your progress and addressing any concerns.

Suitable For

Adult patients who are typically recommended for intestinal transplant include those with complicated intestinal failure, motility disorders, desmoid tumors, and other life-threatening or debilitating conditions. Graft type for adult recipients depends on the unique anatomical characteristics of the recipient, with colonic inclusion becoming more common and associated with improved outcomes. Overall, outcomes for adult intestinal transplant recipients have steadily improved over the past two decades. Intestinal transplantation remains a mainstay therapy for complex intestinal failure in adult patients.

Timeline

Before intestinal transplant:

  1. Patient experiences symptoms of intestinal failure, such as severe diarrhea, weight loss, malnutrition, and inability to absorb nutrients.
  2. Patient undergoes extensive medical evaluations to determine if they are a suitable candidate for intestinal transplant.
  3. Patient is placed on the waiting list for a suitable donor intestine.
  4. Patient may require parenteral nutrition or other supportive treatments to manage their condition while waiting for transplant.

After intestinal transplant:

  1. Patient undergoes the intestinal transplant surgery, which can last several hours and may involve removal of the diseased intestine.
  2. Patient is closely monitored in the intensive care unit post-transplant to watch for signs of rejection or infection.
  3. Patient may experience complications post-transplant, such as rejection, infection, or graft-versus-host disease.
  4. Patient undergoes regular follow-up appointments and monitoring to ensure the success of the transplant and manage any complications.
  5. Patient gradually recovers and experiences improvements in their quality of life, such as improved digestion and absorption of nutrients.
  6. Patient may need to take immunosuppressive medications for the rest of their life to prevent rejection of the transplanted intestine.

What to Ask Your Doctor

  1. What are the specific risks and benefits of an intestinal transplant for my individual case?
  2. How likely is it that the transplant will be successful in improving my condition and quality of life?
  3. What is the expected recovery time and post-transplant care regimen?
  4. What are the potential complications and long-term side effects of an intestinal transplant?
  5. How will the transplant affect my overall health and immune system?
  6. What is the success rate of intestinal transplants at this facility?
  7. Will I need to take immunosuppressant medications for the rest of my life after the transplant?
  8. How often will I need to follow up with the transplant team after the procedure?
  9. Are there any alternative treatments or therapies that might be considered before proceeding with an intestinal transplant?
  10. What are the financial considerations and insurance coverage options for an intestinal transplant?

Reference

Authors: Matsumoto CS, Subramanian S, Fishbein TM. Journal: Gastroenterol Clin North Am. 2018 Jun;47(2):341-354. doi: 10.1016/j.gtc.2018.01.011. Epub 2018 Apr 4. PMID: 29735028