Our Summary

This research paper examines the role of intestinal transplantation (ITx), a medical procedure where a diseased or failing intestine is replaced with a healthy one, in treating patients suffering from chronic intestinal failure or extensive blood clotting in the mesenteric veins. The main goal of this treatment is not only to make patients capable of absorbing nutrients on their own but also to reduce the risk of short-term and long-term complications.

However, data on the nutritional care of ITx patients before, during, and after the operation is limited due to the small number of patients undergoing this treatment at each medical center. To address this, the authors of the study reviewed available scientific data and combined it with their own experience treating 28 ITx patients at the University Hospitals Leuven in Belgium.

They found that although there’s no specific study on ITx, they could apply some findings from other solid organ transplant studies. For example, “prehabilitation,” or preparing patients physically and mentally before the surgery, might be important. It’s also crucial to maintain kidney and liver function before the transplant.

Transitioning patients from parenteral nutrition (receiving nutrients through an IV) to enteral (using the digestive tract) and oral nutrition after the surgery can be complicated due to the surgical procedures involved and possible complications. The ultimate goal, however, is to make patients capable of eating and absorbing nutrients on their own, while also minimizing the risk of infections from food by teaching them safe food practices.

FAQs

  1. What is the purpose of intestinal transplantation (ITx)?
  2. What are some of the complications that could necessitate dietary interventions after an intestinal transplant?
  3. How does the transition from parenteral to enteral and oral nutrition occur after an intestinal transplant?

Doctor’s Tip

One helpful tip a doctor might tell a patient about intestinal transplant is to focus on prehabilitation before the surgery. This includes preserving kidney and liver function in the pretransplant period and optimizing overall health and nutrition to improve outcomes post-surgery. It is also important to work closely with a nutritionist to transition from parenteral to enteral and oral nutrition in a safe and effective manner. Additionally, following proper food safety practices to minimize the risk of foodborne infections is crucial for long-term success after an intestinal transplant.

Suitable For

Patients who are typically recommended for intestinal transplant are those with chronic intestinal failure or extensive venous mesenteric thrombosis. These patients are unable to absorb nutrients properly and rely on parenteral nutrition for their nutritional needs. Intestinal transplantation aims to restore nutritional autonomy and minimize the risk of complications in these patients. Patients may also be recommended for intestinal transplant if they have experienced surgical complications necessitating dietary interventions or if they are stable outpatient transplant recipients. It is important to consider prehabilitation and preserving kidney and liver function in the pretransplant period, as well as transitioning from parenteral to enteral and oral nutrition post-transplant. Ultimately, the goal is to give patients nutritional autonomy while minimizing the risk of foodborne infections through education on well-tolerated food practices.

Timeline

Before Intestinal Transplant:

  • Patients with chronic intestinal failure or extensive venous mesenteric thrombosis may be considered for intestinal transplantation as a treatment option.
  • Patients may undergo preoperative evaluations and tests to assess their overall health and suitability for transplantation.
  • Patients may receive nutritional support through parenteral nutrition to maintain their nutritional status.
  • Prehabilitation and preservation of kidney and liver function may be important in the pretransplant period.

After Intestinal Transplant:

  • Patients undergo the surgical procedure for intestinal transplantation.
  • Patients may experience surgical complications that necessitate dietary interventions.
  • Transition from parenteral to enteral and oral nutrition may be complex due to surgical procedures and possible complications.
  • The goal is to give patients nutritional autonomy while minimizing the risk of foodborne infections through education on well-tolerated food practices.
  • Patients are monitored closely in the postoperative period to ensure proper healing and function of the transplanted intestine.
  • Long-term follow-up is necessary to monitor for complications and ensure the success of the transplant.

What to Ask Your Doctor

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

  1. What is the success rate of intestinal transplant surgery?
  2. What are the potential risks and complications associated with intestinal transplant surgery?
  3. How long is the recovery process after intestinal transplant surgery?
  4. Will I need to take immunosuppressant medications after the transplant, and what are the potential side effects?
  5. How will my diet and nutrition needs change after the transplant?
  6. What kind of follow-up care will I need after the transplant surgery?
  7. What is the long-term outlook for patients who undergo intestinal transplant surgery?
  8. How often will I need to have check-ups and monitoring after the transplant?
  9. Are there any lifestyle changes I should make after the transplant to improve my outcomes?
  10. Are there any support groups or resources available for patients who have undergone intestinal transplant surgery?

Reference

Authors: Van Oosterwyck A, Lauwers N, Pauwels N, Vanuytsel T. Journal: Curr Opin Clin Nutr Metab Care. 2023 Mar 1;26(2):105-113. doi: 10.1097/MCO.0000000000000901. Epub 2022 Dec 23. PMID: 36728936