Our Summary

This research paper is about new ways to prevent the body from rejecting a transplanted intestine, as well as ways to manage a common issue with transplants called graft-versus-host disease, where the donated organ attacks the recipient’s body.

Transplanting intestines is particularly difficult because the organ has a lot of immune cells which can cause rejection or graft-versus-host disease, and to prevent this, strong medications that suppress the immune system are needed. But these medications can cause additional health problems.

There isn’t a lot of information available about the best ways to perform intestine transplants because it’s not a common procedure and few places have experience with it.

However, recent research is beginning to change how these transplants are done. More and more, a drug called basilixumab is being used at the start of treatment, and there’s also consideration of using another drug called alemtuzumab. For ongoing care after the transplant, drugs that inhibit a protein called mTOR and antimetabolites are being used.

For handling rejection, new roles have been found for a protein that causes inflammation (tumor necrosis factor-α), for a substance that helps immune cells move to the right places (α4β7 integrin), for changing the bacteria in the gut (microbiome modulation), for protocols that make the body less likely to react to the new organ (desensitization protocols), and for strategies that make the body accept the new organ (tolerance induction strategies).

The paper also discusses potential new treatments for graft-versus-host disease, especially a promising one that inhibits a protein called Janus kinase.

Overall, these new approaches to preventing rejection and graft-versus-host disease are more targeted than previous ones and could potentially cause fewer health problems. More research is needed to confirm their benefits and make them widely available.

FAQs

  1. What makes the intestine a complex organ for transplantation?
  2. What are the recent developments in immunosuppression therapies for intestinal transplants?
  3. What are the potential novel therapies for graft-versus-host disease (GVHD) in intestinal transplants?

Doctor’s Tip

A helpful tip a doctor might tell a patient about intestinal transplant is to discuss with their healthcare team about the latest advancements in immunosuppressive therapies and to stay informed about emerging treatments for rejection and graft-versus-host disease. It is important for patients to actively participate in their treatment plan and stay engaged in discussions with their medical team to ensure the best possible outcomes after an intestinal transplant.

Suitable For

Patients who are typically recommended for intestinal transplant are those with irreversible intestinal failure, often due to conditions such as necrotizing enterocolitis, short bowel syndrome, and motility disorders. These patients may have complications such as malnutrition, dehydration, sepsis, and failure to thrive. Intestinal transplant may be considered when other treatment options, such as parenteral nutrition, have failed to improve the patient’s condition. It is important to note that intestinal transplant is a complex procedure with high risk of rejection and graft-versus-host disease, so careful patient selection is crucial.

Timeline

Before intestinal transplant:

  1. Patient undergoes thorough evaluation by a multidisciplinary team to determine candidacy for transplant.
  2. Patient is placed on the transplant waiting list and waits for a suitable donor organ to become available.
  3. Patient may undergo various pre-transplant tests and procedures to prepare for the transplant surgery.
  4. Patient may require temporary measures such as total parenteral nutrition (TPN) to maintain nutrition and hydration while awaiting transplant.

After intestinal transplant:

  1. Patient undergoes surgery to receive the intestinal transplant.
  2. Patient is closely monitored in the intensive care unit (ICU) post-transplant for any complications.
  3. Patient begins a regimen of immunosuppressive medications to prevent rejection of the transplanted organ.
  4. Patient undergoes regular follow-up appointments and monitoring to assess the function of the transplanted intestine and adjust medications as needed.
  5. Patient may experience complications such as rejection, graft-versus-host disease (GVHD), or infections, which require additional treatment and management.
  6. Patient undergoes ongoing rehabilitation and support to adjust to life with a new intestine and manage any long-term effects of the transplant.

What to Ask Your Doctor

Some questions a patient should ask their doctor about intestinal transplant include:

  1. What type of immunosuppression medication will I need to take after the transplant?
  2. What are the potential side effects of the immunosuppression medications?
  3. How often will I need to have follow-up appointments after the transplant?
  4. What signs or symptoms should I watch out for that may indicate rejection or GVHD?
  5. Are there any specific dietary or lifestyle changes I should make after the transplant?
  6. How long is the recovery process expected to be?
  7. What is the success rate of intestinal transplants at your center?
  8. Are there any alternative or experimental therapies that I should consider?
  9. How will the transplant impact my overall quality of life?
  10. Are there any support groups or resources available for intestinal transplant recipients?

Reference

Authors: Merola J, Shamim A, Weiner J. Journal: Curr Opin Organ Transplant. 2022 Apr 1;27(2):119-125. doi: 10.1097/MOT.0000000000000958. PMID: 35232925