Our Summary

Transplanting intestines has changed from being an experimental practice in the mid-20th century to now a well-established treatment for patients who have severe intestinal failure and for whom parenteral nutrition is not effective. The main cause for intestinal failure in both adults and children is short-bowel syndrome, along with many other diseases that can lead to this. There have been several challenges to overcome in developing intestinal transplantation, such as technical difficulties, challenges with immunity, and infection risks. However, the success rate has risen over the years due to advancements in surgical techniques, new immune-suppressing treatments and better strategies for monitoring and managing patients after transplant. Almost 2800 intestinal transplants have been done worldwide, and survival rates for patients and grafts are now similar to other types of organ transplants. As the number of these patients grows, it’s expected that they will need imaging services from places other than transplant centers. Therefore, it’s important for radiologists to understand the procedure, its common variations, and possible post-operative complications. This paper provides an overview of intestinal transplantation, including reasons for the procedure, variations, expected post-operative anatomy, and range of potential complications.

FAQs

  1. What is the main cause for intestinal failure that leads to the need for a transplant?
  2. What challenges have been overcome in developing intestinal transplantation techniques?
  3. What is the role of radiologists in the process of intestinal transplantation?

Doctor’s Tip

One helpful tip a doctor might give a patient undergoing an intestinal transplant is to closely follow their post-operative care plan. This typically includes taking immunosuppressant medications as prescribed, attending regular follow-up appointments, following a specific diet recommended by the medical team, and avoiding certain activities that could put strain on the newly transplanted intestines. By following their care plan diligently, patients can help ensure the success of their transplant and minimize the risk of complications.

Suitable For

Patients who are typically recommended for intestinal transplant include those with:

  1. Short-bowel syndrome: This is the most common reason for intestinal failure, where a significant portion of the small intestine is either missing or non-functioning. This can be due to surgical removal of the intestine, congenital defects, or diseases such as necrotizing enterocolitis or volvulus.

  2. Chronic intestinal pseudo-obstruction: This is a rare condition where the intestines are unable to contract and move food and waste through the digestive system effectively.

  3. Motility disorders: Conditions such as gastroparesis or chronic idiopathic intestinal pseudo-obstruction can lead to severe dysfunction of the intestines and may require transplant.

  4. Inflammatory bowel disease: Severe cases of Crohn’s disease or ulcerative colitis that cannot be managed with medication or surgery may necessitate intestinal transplant.

  5. Intestinal tumors: Patients with benign or malignant tumors in the intestines that cannot be surgically removed may benefit from transplant.

  6. Vascular disorders: Conditions such as mesenteric ischemia or chronic mesenteric venous thrombosis can lead to inadequate blood flow to the intestines and may require transplant.

  7. Complications from previous surgeries: Patients who have had multiple abdominal surgeries resulting in short-bowel syndrome or other intestinal complications may be candidates for transplant.

Overall, patients who have severe intestinal failure that cannot be effectively managed with other treatments, such as parenteral nutrition, may be recommended for intestinal transplant. It is important for these patients to undergo a thorough evaluation by a multidisciplinary team to determine if they are suitable candidates for the procedure.

Timeline

Before an intestinal transplant, a patient typically undergoes extensive evaluation and testing to determine their eligibility for the procedure. This may include blood tests, imaging studies, and consultations with various specialists. Once deemed a suitable candidate, the patient is placed on a waiting list for a donor intestine.

After receiving a transplant, the patient will be closely monitored in the hospital for signs of rejection or infection. Immunosuppressive medications will be prescribed to prevent the body from rejecting the new organ. The patient will gradually resume eating and may require additional support such as parenteral nutrition until the transplanted intestine is fully functioning.

In the months and years following the transplant, the patient will continue to be monitored for signs of rejection, infection, and other complications. Regular follow-up appointments with the transplant team will be necessary to ensure the long-term success of the transplant.

Overall, the timeline for a patient before and after an intestinal transplant involves a thorough evaluation process, surgical procedure, post-operative care, and long-term monitoring to ensure the best possible outcome for the patient.

What to Ask Your Doctor

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

  1. Am I a candidate for an intestinal transplant? What criteria do I need to meet in order to be considered for the procedure?
  2. What are the risks and benefits of intestinal transplantation for my specific condition?
  3. How many intestinal transplants has the transplant center performed? What is their success rate?
  4. What is the recovery process like after an intestinal transplant? How long will I need to stay in the hospital?
  5. What medications will I need to take after the transplant? What are the potential side effects of these medications?
  6. How will my diet need to change after the transplant? Will I still need to rely on parenteral nutrition?
  7. What are the potential complications or risks associated with intestinal transplantation? How will these be monitored and managed?
  8. How frequently will I need to follow up with my transplant team after the procedure?
  9. What support services are available for transplant patients, such as nutrition counseling or mental health support?
  10. Are there any alternative treatments or therapies that I should consider before proceeding with an intestinal transplant?

Reference

Authors: Rees MA, Amesur NB, Cruz RJ, Borhani AA, Abu-Elmagd KM, Costa G, Dasyam AK. Journal: Radiographics. 2018 Mar-Apr;38(2):413-432. doi: 10.1148/rg.2018170086. PMID: 29528830