Our Summary

An ostomy is a surgical procedure that creates an opening in the body to discharge waste. While these procedures can be beneficial, they can also lead to serious complications, especially when the ostomy is later reversed. Recent research has suggested that in some cases, the same survival rates for patients and grafts (the transplanted organ) can be achieved without using ostomies. This has led to a re-evaluation of the need for ostomies in intestine transplants in some major transplant centers. However, more time and studies are needed to fully understand the risks and benefits of not using ostomies in intestine transplants.

FAQs

  1. What is an ostomy and why is it used in intestinal transplants?
  2. What are some potential complications of ostomy procedures?
  3. Why are some major transplant centers re-evaluating the need for ostomies in intestine transplants?

Doctor’s Tip

It is important to closely follow your doctor’s post-transplant care instructions, including taking prescribed medications, attending regular follow-up appointments, and maintaining a healthy diet and lifestyle. It is also important to be aware of any signs of rejection or complications and to report them to your healthcare team immediately. Engaging in open communication with your healthcare team and following their guidance will help ensure the success of your intestinal transplant.

Suitable For

Patients who may be recommended for an intestinal transplant typically have severe intestinal failure or complications from conditions such as:

  • Short bowel syndrome
  • Chronic intestinal pseudo-obstruction
  • Intestinal ischemia
  • Inflammatory bowel disease (such as Crohn’s disease)
  • Motility disorders
  • Intestinal tumors or polyps

These patients may have symptoms such as severe diarrhea, abdominal pain, malnutrition, weight loss, and difficulty absorbing nutrients from food. They may also have complications such as sepsis, liver failure, or intestinal failure-associated liver disease (IFALD).

Patients who have not responded well to other treatments, such as parenteral nutrition or medication, may be considered for an intestinal transplant. The decision to recommend a transplant is typically made by a multidisciplinary team of healthcare providers, including gastroenterologists, surgeons, transplant specialists, and nutritionists.

It is important for patients to discuss their individual case with their healthcare providers to determine if an intestinal transplant is the best option for them. Transplant surgery is a complex procedure with potential risks and complications, so careful evaluation and consideration are necessary before moving forward with the transplant.

Timeline

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

Before Intestinal Transplant:

  1. Patient is diagnosed with end-stage intestinal failure or other conditions necessitating an intestinal transplant.
  2. Patient undergoes extensive medical evaluations to determine eligibility for transplant.
  3. Patient is placed on the transplant waiting list and waits for a suitable donor match.
  4. Patient undergoes pre-transplant treatments and preparations, including immunosuppressive therapy.

During Intestinal Transplant:

  1. Patient undergoes the intestinal transplant surgery, which can take several hours.
  2. Patient is closely monitored in the intensive care unit immediately following the surgery.
  3. Patient may experience complications such as rejection or infection, which are treated with medications and other interventions.

After Intestinal Transplant:

  1. Patient continues to receive post-transplant care, including regular monitoring of organ function and medication management.
  2. Patient may need to adjust to dietary changes and lifestyle modifications to support the transplanted intestine.
  3. Patient may experience complications or rejection episodes that require additional treatment.
  4. Patient gradually resumes normal activities and improves their quality of life as the transplanted intestine functions effectively.
  5. Patient may need ongoing medical follow-up and support to ensure long-term success of the transplant.

What to Ask Your Doctor

Here are some questions a patient should ask their doctor about intestinal transplant:

  1. What are the potential risks and complications associated with an intestinal transplant?
  2. How long is the recovery process expected to be 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 lifestyle changes I will need to make after the transplant?
  6. What are the chances of rejection of the transplanted intestine, and how is this monitored and treated?
  7. What are the long-term success rates of intestinal transplants?
  8. What is the role of ostomies in intestinal transplants, and are there alternatives to using an ostomy?
  9. How will the transplant impact my ability to digest food and absorb nutrients?
  10. Are there any support groups or resources available for patients who have undergone an intestinal transplant?

Reference

Authors: Tekin A, Selvaggi G, Pfeiffer BJ, Garcia J, Venkatasamy VV, Nunes Dos Santos RM, Vianna RM. Journal: Gastroenterol Clin North Am. 2024 Jun;53(2):299-308. doi: 10.1016/j.gtc.2024.03.001. Epub 2024 Apr 6. PMID: 38719380