Our Summary

This research paper discusses improvements in living donor intestinal transplantation (LDIT), a procedure where a healthy person donates a part of their intestine to someone whose intestine is failing. The results of this procedure are now similar to those where the intestine is obtained from a deceased donor. However, LDIT should be used in specific cases and with careful patient selection. It is most beneficial when both the intestine and liver are transplanted from a living donor to a child who has both intestinal and liver failure. This can potentially save lives as it eliminates the waiting time for organs, usually from deceased donors, which can often lead to high mortality rates. LDIT can also be used in cases where recipients have a high sensitivity to foreign organs, allowing for procedures to reduce this sensitivity. If the donor is an identical twin or a sibling with identical HLA (a group of proteins the immune system uses to recognize foreign cells), LDIT has significant advantages due to better immune compatibility.

FAQs

  1. What is living donor intestinal transplantation (LDIT)?
  2. What are the specific indications for LDIT and how is patient selection done?
  3. What is the potential benefit of LDIT in highly sensitized recipients?

Doctor’s Tip

One helpful tip a doctor might tell a patient about intestinal transplant is to carefully consider the option of living donor intestinal transplantation, especially in cases where there is a specific indication and patient selection. This type of transplant can offer comparable results to deceased donor transplants and may be particularly beneficial for pediatric recipients with intestinal and hepatic failure. Additionally, in cases where there is a highly sensitized recipient or an available identical twin or HLA-identical sibling, living donor intestinal transplantation may have significant immunologic advantages and should be considered as an option.

Suitable For

Patients who are typically recommended for intestinal transplant include those with intestinal and hepatic failure, particularly pediatric recipients who may benefit from combined living donor intestinal/liver transplantation. Additionally, highly sensitized recipients who may benefit from de-sensitization protocols, as well as patients with available identical twins or HLA-identical siblings, may also be candidates for intestinal transplant. It is important to carefully select patients for living donor intestinal transplantation and limit it to specific indications to ensure optimal outcomes.

Timeline

Timeline of a patient’s experience before and after intestinal transplant:

Before transplant:

  1. Patient is diagnosed with intestinal failure and is not responding to conventional treatments.
  2. Patient is evaluated by a transplant team to determine if they are a candidate for intestinal transplant.
  3. Patient is placed on the waiting list for a deceased donor intestinal transplant.
  4. Patient experiences complications related to their intestinal failure, such as malnutrition, dehydration, and frequent hospitalizations.

After transplant:

  1. Patient undergoes living donor intestinal transplant surgery.
  2. Patient receives immunosuppressive medications to prevent rejection of the transplanted organ.
  3. Patient is monitored closely for signs of rejection, infection, and other complications.
  4. Patient undergoes rehabilitation and physical therapy to regain strength and function.
  5. Patient gradually resumes normal activities and diet, with close monitoring by the transplant team.
  6. Patient experiences improved quality of life and may be able to return to work or school.
  7. Patient continues regular follow-up appointments with the transplant team to monitor the long-term success of the transplant.

What to Ask Your Doctor

  1. What are the risks and benefits of intestinal transplant surgery?
  2. What criteria determine if I am a suitable candidate for an intestinal transplant?
  3. How long is the recovery process after intestinal transplant surgery?
  4. What medications will I need to take after the transplant, and what are the potential side effects?
  5. How often will I need to follow up with the transplant team after the surgery?
  6. What is the success rate of intestinal transplants, and what factors can affect the outcome?
  7. Are there any alternative treatments to intestinal transplant that I should consider?
  8. How long can an intestinal transplant be expected to last, and are there any potential complications or risks of rejection?
  9. How will the transplant team monitor for signs of rejection or infection after the surgery?
  10. What lifestyle changes or dietary restrictions will I need to follow post-transplant to support the success of the new organ?

Reference

Authors: Tzvetanov IG, Tulla KA, D’Amico G, Benedetti E. Journal: Gastroenterol Clin North Am. 2018 Jun;47(2):369-380. doi: 10.1016/j.gtc.2018.01.008. Epub 2018 Apr 4. PMID: 29735030