Our Summary

This article is a review of the recent progress in intestinal transplant procedures. Intestinal transplants are not just for patients who have no other options left, but are now more widely used due to advancements in medical and surgical techniques.

The survival rate after five years for some types of grafts (transplanted organs or tissues) is over 80% in high-volume medical centers. Researchers now understand better how the recipient’s and the transplanted organ’s immune responses interact, which helps them to personalize the use of drugs that suppress the immune system and prevent rejection of the graft.

Some medical centers are now performing “no-stoma” transplants, which means they don’t create an opening (stoma) in the body for waste to leave. Early results show this doesn’t have negative effects, and other surgical improvements have reduced the stress the transplant puts on the body.

Transplant centers are encouraging doctors to refer patients earlier, before issues like difficult-to-access blood vessels or liver disease make the transplant more challenging.

In summary, doctors should consider intestinal transplants as a good option for patients with intestinal failure, untreatable abdominal tumors, or severe abdominal emergencies.

FAQs

  1. Who are the ideal candidates for an intestinal transplant?
  2. What are the recent medical and surgical advances in intestinal transplantation?
  3. What does the term ’no-stoma’ transplants refer to and what are its potential effects?

Doctor’s Tip

One helpful tip a doctor might tell a patient about intestinal transplant is to ensure they are referred to a transplant center early in the treatment process. Early referral can help prevent complications and increase the success of the transplant procedure. Additionally, patients should discuss with their healthcare team the possibility of individualized immunosuppression to help balance the host and graft immune responses. It is also important for patients to follow their transplant center’s guidelines for post-transplant care to ensure the best possible outcome.

Suitable For

Patients who are typically recommended for intestinal transplant include those with intestinal failure, benign unresectable abdominal tumors, or acute abdominal catastrophes. It is important for clinicians to consider this option for patients who have exhausted other treatment options and who may benefit from a transplant to improve their quality of life and overall prognosis. Referral to a transplant center should be made early to prevent complications and improve outcomes.

Timeline

Before intestinal transplant:

  1. Patient is diagnosed with intestinal failure, benign unresectable abdominal tumors, or acute abdominal catastrophes.
  2. Patient undergoes thorough evaluation by transplant team to determine eligibility for transplant.
  3. Patient may undergo pre-transplant tests and screenings to assess overall health and suitability for transplant.
  4. Patient may be placed on a waiting list for a suitable donor organ.
  5. Patient may undergo pre-transplant treatments or interventions to stabilize their condition before transplant.

After intestinal transplant:

  1. Patient undergoes the transplant surgery, which may involve the transplantation of the small intestine, large intestine, or both.
  2. Patient is closely monitored in the immediate post-operative period for complications and signs of organ rejection.
  3. Patient may need to stay in the hospital for an extended period of time for recovery and monitoring.
  4. Patient undergoes regular follow-up appointments with the transplant team to monitor organ function and adjust immunosuppressive medications.
  5. Patient may need ongoing support and care to manage the physical and psychological challenges of living with a transplanted intestine.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with an intestinal transplant?
  2. How long is the recovery process and what type of post-transplant care will be required?
  3. What are the success rates for intestinal transplants at your facility?
  4. How will the transplant impact my current medications and overall health?
  5. Are there any alternative treatments or therapies that I should consider before proceeding with an intestinal transplant?
  6. How will the transplant affect my diet and nutritional needs?
  7. What is the long-term prognosis for patients who undergo an intestinal transplant?
  8. Are there any specific lifestyle changes or precautions that I will need to take after the transplant?
  9. How often will I need to follow up with the transplant team after the procedure?
  10. Are there any specific criteria or eligibility requirements that I need to meet in order to be considered for an intestinal transplant?

Reference

Authors: Sharkey LM, Russell NK. Journal: Curr Opin Gastroenterol. 2023 May 1;39(3):242-248. doi: 10.1097/MOG.0000000000000933. Epub 2023 Mar 28. PMID: 37097770