Our Summary

This research paper explores the history and challenges of intestinal transplantation, a surgical procedure where a diseased portion of the intestine is replaced with a healthy one. While progress has been made, the intestine is more difficult to transplant than other organs and experiences higher rates of rejection and lower long-term survival. However, re-transplantation, or performing the transplant again, is increasingly seen as a good option and is now the fourth most common reason for intestinal transplants. Changes in how we manage the immune system’s response, improvements in surgical techniques, and better monitoring of infectious diseases have all contributed to better results. The authors review past studies on re-transplantation, considerations for managing these cases, and potential future developments in this field.

FAQs

  1. What factors have contributed to the improvements in intestinal re-transplantation outcomes?
  2. Why is the intestine more challenging to transplant compared to other solid organs?
  3. How common is intestinal re-transplantation compared to other types of transplantation?

Doctor’s Tip

One helpful tip a doctor might tell a patient about intestinal transplant is to carefully follow all post-transplant medication and follow-up appointments to ensure the best possible outcome. It is important to communicate any changes in symptoms or concerns to your healthcare team promptly. Additionally, maintaining a healthy lifestyle, including a balanced diet and regular exercise, can help support the success of the transplant.

Suitable For

Patients who may be recommended for intestinal transplant typically include those with intestinal failure, such as those with short bowel syndrome, severe inflammatory bowel disease, chronic intestinal pseudo-obstruction, or congenital abnormalities of the intestine. These patients may have failed conventional treatments such as total parenteral nutrition and may have complications such as liver failure or recurrent infections. Patients with recurrent graft failure or complications from a previous intestinal transplant may also be candidates for re-transplantation. Additionally, patients with complications from other solid organ transplants that affect the functioning of the intestine may also be considered for intestinal transplantation.

Timeline

Before intestinal transplant:

  • Patient experiences intestinal failure, often due to a variety of underlying conditions such as short bowel syndrome, inflammatory bowel disease, or vascular disorders
  • Patient undergoes extensive evaluation and testing to determine if they are a suitable candidate for intestinal transplant
  • Patient may require parenteral nutrition or other forms of medical management to support their failing intestine
  • Patient is placed on the transplant waiting list and waits for a suitable donor organ to become available

After intestinal transplant:

  • Patient undergoes surgery to receive the new intestine, along with potentially other organs such as the liver or pancreas
  • Patient is closely monitored in the hospital for signs of graft rejection or other complications
  • Patient must take immunosuppressive medications for the rest of their life to prevent rejection of the new organ
  • Patient undergoes extensive rehabilitation and follow-up care to monitor the success of the transplant and manage any complications that may arise

Overall, the process of intestinal transplant is complex and requires ongoing medical management and support to ensure the long-term success of the transplant.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with intestinal transplant surgery?
  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 is the likelihood of experiencing graft rejection after an intestinal transplant?
  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. What dietary and lifestyle changes will I need to make after the transplant?
  8. Are there any specific factors that may impact the success of an intestinal transplant in my case?
  9. What is the availability and process for re-transplantation if needed in the future?
  10. Are there any alternative treatments or therapies that may be considered in conjunction with or instead of an intestinal transplant?

Reference

Authors: Smullin CP, Venick RS, Marcus EA, McDiarmid SV, Yersiz H, Busuttil RW, Farmer DG. Journal: Gastroenterol Clin North Am. 2024 Sep;53(3):453-459. doi: 10.1016/j.gtc.2024.01.004. Epub 2024 Feb 13. PMID: 39068006