Our Summary

The intestines have long been regarded as an “off-limits” body part in the medical field, particularly in terms of organ failure and transplantation. This was largely due to the difficulty of providing necessary nutritional support to patients who experienced intestinal failure. Such patients were often limited to receiving basic comfort care.

In the 1960s, parenteral nutrition (feeding a person intravenously) emerged as a possible replacement therapy. The idea of intestinal transplantation was inspired by the success of other organ transplants, such as heart, kidney, liver, lung, and pancreas.

The first attempt at an isolated intestinal transplant was made by Richard Lillihei in 1967. In 1983, Thomas Starzl performed the first multivisceral (multiple organ) transplant and in 1990, David Grant carried out the first combined liver-intestinal transplant on an adult in Canada.

Since those initial attempts, advances in immunosuppressive therapies (drugs that lower the body’s ability to reject a transplanted organ) and surgical techniques have led to an increase in the number of intestinal transplantations and broadened its application worldwide.

This article provides a historical overview of the progress made in intestinal transplantation over the past 56 years. It’s still a complex and evolving field, with ongoing research and technological developments continuing to shape its future.

FAQs

  1. What is an intestinal transplant and why was it considered the “forbidden organ” for years?
  2. Who performed the first multi visceral transplant and when was it carried out?
  3. What advancements have allowed the increase in indications and worldwide application of intestinal transplantation?

Doctor’s Tip

A helpful tip a doctor might tell a patient about intestinal transplant is to carefully follow all post-operative instructions, including taking immunosuppressive medications as prescribed to prevent rejection of the transplanted intestine. It is also important to attend all follow-up appointments and communicate any changes in symptoms or concerns to your healthcare team promptly. Additionally, maintaining a healthy lifestyle, including a nutritious diet and regular exercise, can help support the success of the transplant.

Suitable For

Patients who are typically recommended for intestinal transplant are those with irreversible intestinal failure, who are unable to tolerate enteral nutrition and require long-term parenteral nutrition. These patients may have conditions such as short bowel syndrome, intestinal pseudo-obstruction, or intestinal ischemia causing severe malnutrition and complications. Intestinal transplant may be considered when other treatment options have failed to improve the patient’s quality of life and nutritional status. Additionally, patients with intestinal failure associated with liver disease may be candidates for combined liver-intestinal transplant. Transplant evaluation and selection criteria may vary among transplant centers, but generally, patients must be medically stable enough to undergo the transplant procedure and able to comply with post-transplant care and immunosuppressive therapy.

Timeline

  • Before intestinal transplant:
  1. Patient experiences intestinal failure, leading to the inability to provide adequate nutritional support.
  2. Patient may receive palliative comfort care as there were no effective treatments available.
  3. Parenteral nutrition becomes the main replacement therapy in the 1960s.
  4. Success of other organ transplants leads to exploration of intestinal transplantation.
  • After intestinal transplant:
  1. First isolated intestinal transplant performed by Richard Lillihei in 1967.
  2. First multi visceral transplant performed by Thomas Starzl in 1983.
  3. First combined liver-intestinal transplant performed by David Grant in 1990.
  4. Advances in immunosuppressive therapies and surgical techniques allow for increased success rates and expansion of indications.
  5. Worldwide application of intestinal transplantation becomes a reality.
  6. Ongoing research and technological advancements continue to shape the field of clinical intestinal transplantation.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with intestinal transplant surgery?
  2. How long is the recovery process after an intestinal transplant and what can I expect in terms of post-operative care?
  3. Will I need to take immunosuppressive medications for the rest of my life after the transplant? What are the potential side effects of these medications?
  4. How successful are intestinal transplants in general and what is the long-term prognosis for patients who undergo this procedure?
  5. What is the likelihood of rejection of the transplanted intestine and how is rejection typically managed?
  6. Are there specific dietary restrictions or lifestyle changes I will need to follow after the transplant?
  7. How often will I need to follow up with my transplant team after the surgery?
  8. What is the experience and success rate of your transplant center with intestinal transplants?
  9. Are there any alternative treatments or therapies that I should consider before proceeding with an intestinal transplant?
  10. Can you provide me with any resources or support groups for patients who have undergone intestinal transplants?

Reference

Authors: Gondolesi GE. Journal: Hum Immunol. 2024 May;85(3):110788. doi: 10.1016/j.humimm.2024.110788. Epub 2024 Mar 22. PMID: 38519405