Our Summary

This research paper discusses the history and potential future of intestinal transplantation. This is a procedure where a diseased intestine is replaced with a healthy one from a donor. It was first successfully performed in the 1980s. However, since then, there has not been much progress in how to keep the donor intestine (the ‘allograft’) in good condition before the transplant. Usually, the allograft is kept in a cold storage, which is not ideal.

The paper suggests a new technique called ’normothermic machine perfusion’. This involves keeping the allograft in a machine that keeps it at normal body temperature and supplies it with blood and nutrients, allowing it to function normally. This not only maintains the organ in a better condition, but also allows doctors to assess and improve its health before transplantation. It also allows the organ to be transported over longer distances.

The research indicates that significant progress has been made in this field over the last 60 years. Animal studies using this technique have shown promising results, suggesting that it may soon be ready for use in humans.

FAQs

  1. What is the current standard for preserving the allograft before intestinal transplantation?
  2. What does normothermic machine perfusion offer in terms of organ preservation and transplantation?
  3. How has the field of intestinal transplantation progressed over the last 60 years?

Doctor’s Tip

A helpful tip a doctor might tell a patient about intestinal transplant is to follow a strict medication regimen as prescribed by your healthcare team. This may include immunosuppressant medications to prevent rejection of the transplanted intestine. It is important to take these medications consistently and as directed to ensure the success of the transplant. Additionally, maintaining a healthy lifestyle, including a balanced diet and regular exercise, can also help support the function of the transplanted intestine. Regular follow-up appointments with your healthcare team will also be important to monitor your progress and address any concerns.

Suitable For

Patients who are typically recommended for intestinal transplant are those with severe intestinal failure, which can result from conditions such as short bowel syndrome, inflammatory bowel disease, congenital defects, or complications from previous surgeries. These patients may have difficulty absorbing nutrients or suffer from recurrent infections or complications that severely impact their quality of life. Intestinal transplant may be considered when other treatment options, such as parenteral nutrition or bowel rehabilitation, are not successful in improving the patient’s condition.

Timeline

Before intestinal transplant:

  • Patient is diagnosed with a severe intestinal disorder or dysfunction that requires transplantation.
  • Patient undergoes a series of tests and evaluations to determine if they are a suitable candidate for transplant.
  • Patient is placed on the transplant waiting list and waits for a suitable donor organ to become available.
  • Patient may experience worsening symptoms and complications from their intestinal disorder while waiting for a transplant.

After intestinal transplant:

  • Patient undergoes the intestinal transplant surgery, which can take several hours to complete.
  • Patient is closely monitored in the intensive care unit post-transplant for any complications or rejection of the new organ.
  • Patient begins a regimen of immunosuppressant medications to prevent rejection of the transplanted organ.
  • Patient undergoes regular follow-up appointments and testing to monitor the function of the transplanted intestine and adjust medications as needed.
  • Patient may experience improvements in their symptoms and quality of life following a successful transplant.

What to Ask Your Doctor

  1. What are the risks and potential complications associated with intestinal transplant surgery?
  2. How long is the recovery process after an intestinal transplant?
  3. What medications will I need to take after the transplant, and what are the potential side effects?
  4. How often will I need to follow up with my transplant team after the surgery?
  5. Are there any dietary restrictions I will need to follow after the transplant?
  6. How will the success of the transplant be monitored in the long term?
  7. Are there any alternative treatment options to intestinal transplant that I should consider?
  8. What is the long-term prognosis for patients who undergo intestinal transplant surgery?
  9. How experienced is the transplant team in performing intestinal transplants?
  10. What is the availability of donor organs for intestinal transplants?

Reference

Authors: Ladowski JM, Sudan DL. Journal: Gastroenterol Clin North Am. 2024 Jun;53(2):221-231. doi: 10.1016/j.gtc.2024.01.006. Epub 2024 Mar 19. PMID: 38719374