Our Summary

This paper reviews the field of intestinal transplantation, which has become the main treatment for patients with irreversible intestinal failure caused by complications from total parenteral nutrition. In the past, retransplantation (performing a second transplant after the first has failed) had very high rates of complications and patient deaths. However, recent studies have shown a significant improvement in patient survival and graft survival (the success of the transplanted organ) after retransplantation.

The paper discusses the most common reasons for retransplantation, the surgical techniques used, when to remove the graft, how to monitor the patient’s immune response, and potential complications. It also highlights the advances in managing immunosuppression (drugs that reduce the body’s immune response to prevent it from rejecting the transplant) and the benefits of using liver-containing grafts.

In conclusion, the paper suggests that due to the improved survival rates, intestinal retransplantation should be considered more often. It also emphasizes that the success of retransplantation is due to better immunosuppression protocols, surgical techniques, choosing the right time for surgery, and better monitoring for infections.

FAQs

  1. What is the purpose of intestinal transplantation and who are the typical patients for this treatment?
  2. How has the field of intestinal retransplantation evolved and improved over recent years?
  3. What factors have contributed to improved outcomes in intestinal retransplantation?

Doctor’s Tip

One helpful tip a doctor might tell a patient about intestinal transplant is to closely follow the prescribed immunosuppression medication regimen. These medications are crucial for preventing rejection of the transplanted intestine. It is important to take these medications as directed by your healthcare team to ensure the success of the transplant and reduce the risk of complications. Regular monitoring and communication with your healthcare team are also essential for optimal outcomes after intestinal transplant.

Suitable For

Patients who are typically recommended for intestinal transplant are those who suffer from irreversible intestinal failure and complications of total parenteral nutrition. These patients may have conditions such as short gut syndrome, intestinal dysmotility, or chronic intestinal pseudo-obstruction. In particular, patients who have failed multiple treatments and therapies for their condition may be considered for intestinal transplant.

Additionally, patients who have experienced graft failure or complications following a previous intestinal transplant may also be recommended for retransplantation. Recent studies have shown significant improvements in patient and graft survival rates after intestinal retransplantation, making it a viable option for select patients.

Overall, the decision to recommend intestinal transplant or retransplantation is made on a case-by-case basis, taking into consideration the patient’s medical history, current condition, and potential benefits and risks of the procedure. It is important for patients to be evaluated by a multidisciplinary team of transplant specialists to determine if intestinal transplant is the most appropriate treatment option for their individual situation.

Timeline

Before intestinal transplant:

  • Patients suffering from irreversible intestinal failure and complications from total parenteral nutrition may be considered for intestinal transplant.
  • Patients undergo extensive evaluation and testing to determine if they are suitable candidates for transplant.
  • Once deemed eligible, patients are placed on a waiting list for a suitable donor organ.
  • Patients may experience complications and deteriorating health while waiting for a transplant.

After intestinal transplant:

  • Patients undergo the transplant surgery, which involves removing the diseased intestine and replacing it with a healthy donor intestine.
  • Patients are closely monitored in the intensive care unit post-transplant for any complications or rejection.
  • Patients will need to take immunosuppressant medication for the rest of their lives to prevent rejection of the donor organ.
  • Patients will undergo regular follow-up appointments and monitoring to ensure the success of the transplant.
  • With proper care and adherence to medication, patients can experience improved quality of life and long-term survival after intestinal transplant.

What to Ask Your Doctor

Questions a patient should ask their doctor about intestinal transplant may include:

  1. What are the potential risks and complications associated with intestinal transplant surgery?
  2. How long is the recovery process after intestinal transplant surgery?
  3. What is the success rate of intestinal transplant surgery?
  4. How will I need to adjust my diet and lifestyle after intestinal transplant surgery?
  5. What medications will I need to take after intestinal transplant surgery?
  6. How often will I need to follow up with my medical team after intestinal transplant surgery?
  7. What signs or symptoms should I watch for that may indicate rejection or complications after intestinal transplant surgery?
  8. Are there any long-term effects or risks associated with intestinal transplant surgery?
  9. How will my quality of life be impacted after intestinal transplant surgery?
  10. Are there any alternative treatments or options to consider before pursuing intestinal transplant surgery?

Reference

Authors: Ganoza A, Celik N, Mazariegos GV. Journal: Curr Opin Organ Transplant. 2018 Apr;23(2):224-228. doi: 10.1097/MOT.0000000000000515. PMID: 29465439