Our Summary

Intestinal transplantation, though not very common, has seen significant progress over the last twenty years. This is largely due to improvements in surgical techniques and better methods of suppressing the body’s immune system to prevent it from attacking the new organ. The survival rate after one year of having the transplant is now 76%. Despite this, there are still challenges with the body rejecting the organ over time. Intestinal transplantation is considered a good treatment for patients with intestinal failure, especially those who have severe complications or can’t lead a normal life despite other treatments. This paper aims to discuss the current status, uses, results, and advancements in the field of intestinal transplantation.

FAQs

  1. What is the survival rate after one year of having an intestinal transplant?
  2. Why has there been significant progress in intestinal transplantation over the last twenty years?
  3. Who are the best candidates for an intestinal transplant?

Doctor’s Tip

One helpful tip a doctor might tell a patient about intestinal transplant is to follow a strict medication regimen to prevent rejection of the transplanted organ. This may include taking immunosuppressant drugs as prescribed by your healthcare team and attending regular follow-up appointments to monitor your progress. It is important to communicate any changes in your health or symptoms to your healthcare provider promptly to ensure the best possible outcome after the transplant.

Suitable For

Patients who are typically recommended for intestinal transplant include:

  1. Patients with irreversible intestinal failure: This includes patients who have lost a significant portion of their intestines due to conditions such as Crohn’s disease, necrotizing enterocolitis, or intestinal ischemia. These patients are unable to absorb enough nutrients from food and may require long-term parenteral nutrition.

  2. Patients with complications from parenteral nutrition: Long-term use of parenteral nutrition can lead to complications such as liver failure, infections, and blood clots. In these cases, intestinal transplantation may be considered to improve the patient’s quality of life and reduce the risk of complications.

  3. Patients with severe intestinal motility disorders: Some patients may have conditions such as chronic intestinal pseudo-obstruction or gastroparesis, which affect the movement of food through the intestines. In severe cases, these conditions can lead to malnutrition and require intestinal transplantation to restore normal function.

  4. Patients with recurrent or refractory intestinal infections: In some cases, patients may have recurring infections in the intestines that do not respond to antibiotics or other treatments. Intestinal transplantation may be considered to remove the infected tissue and replace it with a healthy organ.

  5. Patients with intestinal tumors: Rarely, patients may develop tumors in the intestines that are difficult to treat with surgery or chemotherapy. In these cases, intestinal transplantation may be considered to remove the tumor and prevent it from spreading to other parts of the body.

Overall, intestinal transplantation is a complex procedure that is typically reserved for patients with severe intestinal failure who have exhausted other treatment options. Patients undergoing intestinal transplantation require close monitoring and long-term immunosuppression to prevent rejection of the new organ. The decision to undergo intestinal transplantation should be made carefully in collaboration with a multidisciplinary team of transplant specialists, surgeons, and gastroenterologists.

Timeline

Before Intestinal Transplant:

  1. Diagnosis: Patients who are candidates for intestinal transplant typically have intestinal failure, which can be caused by a variety of conditions such as short bowel syndrome, inflammatory bowel disease, or complications from previous surgeries.

  2. Evaluation: Patients undergo a thorough evaluation process to determine if they are suitable candidates for transplantation. This includes medical tests, imaging studies, and consultations with a multidisciplinary team of healthcare professionals.

  3. Waiting for a donor: Once approved for transplantation, patients are placed on a waiting list for a suitable donor organ. The wait time can vary depending on factors such as blood type, body size, and the availability of donor organs.

After Intestinal Transplant:

  1. Surgery: The transplant surgery typically lasts several hours and involves removing the diseased intestine and replacing it with a healthy donor intestine. The new intestine is connected to the patient’s digestive system, allowing them to eat and digest food normally.

  2. Recovery: Patients spend several weeks in the hospital recovering from surgery and monitoring for any complications. They may require intensive care and support from healthcare professionals during this time.

  3. Immunosuppression: Patients must take immunosuppressive medications for the rest of their lives to prevent their immune system from rejecting the new organ. These medications can have side effects and require close monitoring by healthcare providers.

  4. Rehabilitation: After discharge from the hospital, patients undergo rehabilitation to regain strength and function. This may include physical therapy, dietary counseling, and support from a multidisciplinary team of healthcare professionals.

  5. Long-term care: Patients require ongoing medical care and monitoring to ensure the success of the transplant. This may include regular follow-up appointments, blood tests, imaging studies, and adjustments to medications as needed.

Overall, intestinal transplantation can significantly improve the quality of life for patients with intestinal failure. However, it is a complex procedure with potential risks and complications that require careful consideration and ongoing management.

What to Ask Your Doctor

  1. Am I a candidate for intestinal transplantation?
  2. What are the risks and benefits of intestinal transplantation for my specific case?
  3. How long is the recovery process after the transplant surgery?
  4. What is the success rate for intestinal transplants at this hospital or facility?
  5. What medications will I need to take after the transplant and what are the potential side effects?
  6. How often will I need to follow up with my transplant team after the surgery?
  7. How long does an intestinal transplant typically last? Will I need a second transplant in the future?
  8. Are there any lifestyle changes I will need to make after the transplant?
  9. What support services are available for intestinal transplant patients?
  10. Are there any alternative treatments or therapies that I should consider before proceeding with an intestinal transplant?

Reference

Authors: Martinez Rivera A, Wales PW. Journal: Pediatr Surg Int. 2016 Jun;32(6):529-40. doi: 10.1007/s00383-016-3885-2. Epub 2016 Mar 31. PMID: 27033524