Our Summary

Chronic rejection is a major problem for organ transplants, and can lead to failure in 5-10% of cases following intestinal or multivisceral transplants. Diagnosing this is difficult due to unclear symptoms and the only current treatment is removing the transplanted organ. Over the last 20 years, scientists have been trying to understand the immune and non-immune responses that lead to chronic rejection in order to find a way to prevent it. They have found that antibodies specific to the donor organ play a role and methods to combat these in practice are being implemented in transplant centers. However, there’s no standardized protocol yet. Including a liver graft when re-transplanting has shown to have protective effects. More comprehensive studies and clinical trials are needed to understand chronic rejection more thoroughly and find effective treatments.

FAQs

  1. What is chronic rejection and how often does it lead to failure in intestinal or multivisceral transplants?
  2. What role do antibodies specific to the donor organ play in chronic rejection?
  3. Why is including a liver graft when re-transplanting considered to have protective effects?

Doctor’s Tip

It is important to closely follow your doctor’s recommendations after an intestinal transplant, including taking prescribed medications and attending regular follow-up appointments. Be sure to report any new or worsening symptoms to your healthcare team promptly. It is also important to maintain a healthy lifestyle, including eating a balanced diet, staying active, and avoiding tobacco and excessive alcohol consumption. If you have any concerns or questions about chronic rejection or other potential complications, don’t hesitate to discuss them with your healthcare provider.

Suitable For

Patients who are typically recommended for an intestinal transplant are those with irreversible intestinal failure or severe complications from intestinal diseases such as Crohn’s disease, necrotizing enterocolitis, or pseudo-obstruction. These patients may have difficulty absorbing nutrients, severe abdominal pain, and frequent infections due to their intestinal issues. Intestinal transplants may be considered when other treatments, such as parenteral nutrition or bowel lengthening procedures, have failed to improve the patient’s condition.

Timeline

  • Patient is diagnosed with intestinal failure and is put on total parenteral nutrition (TPN) to survive
  • Patient undergoes evaluation and is placed on the waiting list for an intestinal transplant
  • Patient receives a compatible donor organ and undergoes the transplant surgery
  • Patient is monitored closely for signs of rejection and complications post-transplant
  • Patient may experience acute rejection episodes which are treated with immunosuppressive medications
  • If chronic rejection occurs, patient may experience symptoms such as weight loss, diarrhea, abdominal pain, and malnutrition
  • Diagnosis of chronic rejection is difficult and may require biopsies and imaging studies
  • Treatment options for chronic rejection are limited, with removal of the transplanted organ being the only definitive option
  • Research is ongoing to better understand chronic rejection and develop more effective treatments
  • Patient may be considered for re-transplantation with additional protective measures, such as including a liver graft
  • More studies and clinical trials are needed to improve outcomes for patients with chronic rejection after intestinal transplant.

What to Ask Your Doctor

  1. What are the risks and benefits of an intestinal transplant compared to other treatment options?
  2. How likely is chronic rejection to occur after an intestinal transplant?
  3. What are the symptoms of chronic rejection and how is it diagnosed?
  4. What are the current treatment options for chronic rejection?
  5. Are there any preventative measures that can be taken to reduce the risk of chronic rejection?
  6. Are there any clinical trials or new treatments being researched for chronic rejection in intestinal transplants?
  7. What is the success rate of intestinal transplants in preventing chronic rejection?
  8. How often will I need to follow-up with my transplant team after the surgery?
  9. Are there any lifestyle changes or medications I will need to take after the transplant to reduce the risk of chronic rejection?
  10. What are the long-term outcomes and potential complications of an intestinal transplant?

Reference

Authors: Lauro A, Marino IR. Journal: Exp Clin Transplant. 2019 Jan;17(Suppl 1):18-30. doi: 10.6002/ect.MESOT2018.L32. PMID: 30777519