Our Summary

The paper discusses recent advances in the management of intestinal failure, which have led to a decrease in the need for intestine transplants. Despite this, there has been a slight increase in the number of these transplants over the past five years. The paper attributes this increase to improved techniques for transplanting the intestine and closing the abdominal wall, leading to better survival rates for the transplant in the first year. However, the paper notes that this improvement doesn’t extend to survival rates for three and five years after the transplant. The paper suggests that intestine transplants should only be used for patients who have a good chance of surviving and whose other treatment options have failed. The paper also mentions the problem of over-immunosuppression, which is when the body’s immune system is suppressed too much, causing other health problems. New strategies and progress in intestine transplant research could pave the way to solve this issue.

FAQs

  1. Why is there an increase in the number of intestine transplants despite advances in the management of intestinal failure?
  2. What improvements have been made in the techniques for transplanting the intestine and closing the abdominal wall?
  3. What is the problem of over-immunosuppression in intestine transplants and what strategies are being researched to solve this issue?

Doctor’s Tip

One helpful tip a doctor might tell a patient about intestinal transplant is to follow all post-transplant care instructions carefully, including taking medications as prescribed, attending follow-up appointments, and maintaining a healthy lifestyle. It is important to communicate any changes in health or concerns to your medical team promptly to ensure the best possible outcome.

Suitable For

Patients who are typically recommended for intestinal transplants are those who have severe intestinal failure and are not responding to other treatments, such as total parenteral nutrition (TPN) or bowel lengthening procedures. These patients may have conditions such as short bowel syndrome, intestinal dysmotility, or chronic intestinal pseudo-obstruction. Intestinal transplants are usually considered as a last resort when all other treatment options have been exhausted and the patient’s quality of life is severely impacted. Additionally, patients who are at risk of complications from long-term TPN use, such as liver failure or infections, may also be candidates for intestinal transplant. It is important for patients to be carefully evaluated by a multidisciplinary team of specialists to determine if they are suitable candidates for an intestinal transplant.

Timeline

Before intestinal transplant:

  • Patient experiences intestinal failure, often due to conditions such as short bowel syndrome, inflammatory bowel disease, or vascular disorders
  • Patient undergoes extensive medical treatment and management to try to improve intestinal function, including parenteral nutrition, medications, and surgery
  • Patient may experience complications such as infections, malnutrition, and liver disease as a result of intestinal failure

After intestinal transplant:

  • Patient undergoes rigorous evaluation and testing to determine if they are a suitable candidate for a transplant
  • Patient is placed on the waiting list for a suitable donor intestine
  • Patient undergoes the transplant surgery, which can take several hours and involves removing the diseased intestine and replacing it with the donor intestine
  • Patient is closely monitored in the hospital for complications such as rejection, infection, and organ failure
  • Patient undergoes intensive rehabilitation and recovery process, including physical therapy, nutrition counseling, and medication management
  • Patient requires lifelong immunosuppressive medication to prevent rejection of the transplanted intestine
  • Patient continues to be monitored closely for complications and may need additional surgeries or treatments in the future.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with an intestinal transplant?
  2. How long is the recovery process after an intestinal transplant?
  3. What is the success rate of intestinal transplants in terms of long-term survival?
  4. What are the alternative treatment options available for intestinal failure?
  5. How often will I need to take immunosuppressant medications after the transplant?
  6. What is the follow-up care like after an intestinal transplant?
  7. How will an intestinal transplant impact my daily life and activities?
  8. Are there any dietary restrictions I will need to follow post-transplant?
  9. What is the likelihood of rejection of the transplanted intestine and how is this monitored?
  10. Are there any support groups or resources available for patients who have undergone an intestinal transplant?

Reference

Authors: Zorzetti N, Marino IR, Sorrenti S, Navarra GG, D’Andrea V, Lauro A. Journal: Expert Rev Gastroenterol Hepatol. 2023 Jul-Dec;17(7):677-690. doi: 10.1080/17474124.2023.2221433. Epub 2023 Jun 5. PMID: 37264646