Our Summary

The research paper discusses the advancements in intestinal transplantation, a medical procedure that has become a lifesaving option for patients with irreversible intestinal failure. Over time, the survival rate for patients has improved leading to an expansion of the reasons for which this procedure is performed. The process of managing patients with intestinal failure is complicated and involves the collaboration of various specialists to determine who would benefit from rehabilitation versus transplantation.

Advancements in the timing of referrals, patient selection, surgical techniques and understanding the body’s immune response to the transplant have led to improved survival rates for both the patient and the transplanted organ. The effectiveness of the procedure is demonstrated by continuous improvements in the patient’s physical condition, quality of life, and the cost-effectiveness of the procedure. The review covers various aspects, including current practices and evidence-based recommendations for intestinal transplantation.

FAQs

  1. What is intestinal transplantation and who benefits from it?
  2. How have advancements in the field improved the survival rate for patients undergoing intestinal transplantation?
  3. What factors have contributed to the improved effectiveness of intestinal transplantation?

Doctor’s Tip

One helpful tip a doctor might tell a patient about intestinal transplant is to closely follow the post-transplant care plan provided by their medical team. This may include taking immunosuppressant medications as prescribed, attending regular follow-up appointments, maintaining a healthy diet, and avoiding certain activities or substances that could potentially harm the transplanted intestine. By following these guidelines, patients can help ensure the success of their intestinal transplant and reduce the risk of complications.

Suitable For

Patients who are typically recommended for intestinal transplant include those with irreversible intestinal failure, which can be caused by a variety of conditions such as short bowel syndrome, severe inflammatory bowel disease, and congenital abnormalities of the intestine. These patients often have severe malnutrition, dehydration, and complications related to parenteral nutrition, such as liver failure.

Additionally, patients who have failed conventional treatments for their underlying intestinal condition and have a poor quality of life due to their symptoms are also considered for intestinal transplant. Patients who are experiencing frequent hospitalizations, infections, and complications related to their intestinal failure may also be candidates for transplantation.

It is important for patients to be carefully evaluated by a multidisciplinary team of specialists, including gastroenterologists, surgeons, transplant coordinators, and nutritionists, to determine if they would benefit from an intestinal transplant. The decision to recommend transplantation is based on the severity of the patient’s condition, their overall health, and their ability to adhere to the post-transplant care regimen.

Overall, intestinal transplantation is recommended for patients who have exhausted all other treatment options and have a high risk of mortality without the procedure. The advancements in the field have made intestinal transplant a viable and effective option for these patients, leading to improved outcomes and quality of life.

Timeline

Before intestinal transplant:

  1. Patient experiences irreversible intestinal failure due to various reasons such as short bowel syndrome, inflammatory bowel disease, or congenital abnormalities.
  2. Patient undergoes extensive medical management including total parenteral nutrition (TPN) to support their nutritional needs.
  3. Patient may experience complications such as liver failure or recurrent infections due to long-term TPN use.
  4. Patient is evaluated by a multidisciplinary team to determine if they are a candidate for intestinal transplant.
  5. Patient is placed on a waiting list for a suitable donor intestine.

After intestinal transplant:

  1. Patient undergoes intestinal transplant surgery, which involves the removal of the diseased intestine and replacement with a healthy donor intestine.
  2. Patient is monitored closely in the immediate post-operative period for complications such as rejection or infection.
  3. Patient undergoes intensive rehabilitation to regain strength and function post-transplant.
  4. Patient is placed on immunosuppressive medications to prevent rejection of the transplanted organ.
  5. Patient undergoes regular follow-up appointments to monitor the function of the transplanted intestine and adjust medications as needed.
  6. Patient experiences improved quality of life and nutritional status post-transplant.

What to Ask Your Doctor

  1. What is the success rate of intestinal transplants?
  2. What are the risks and potential complications associated with intestinal transplant surgery?
  3. How long is the recovery process after an intestinal transplant?
  4. What is the long-term prognosis for patients who undergo an intestinal transplant?
  5. How will I need to adjust my lifestyle or diet after an intestinal transplant?
  6. What kind of follow-up care will be required after the transplant surgery?
  7. Are there any potential side effects or complications from the immunosuppressant medications required after an intestinal transplant?
  8. How will the transplant team monitor for rejection of the transplanted organ?
  9. What are the criteria for determining if I am a suitable candidate for an intestinal transplant?
  10. How can I best prepare myself mentally and physically for an intestinal transplant surgery?

Reference

Authors: Rege A, Sudan D. Journal: Best Pract Res Clin Gastroenterol. 2016 Apr;30(2):319-35. doi: 10.1016/j.bpg.2016.02.010. Epub 2016 Feb 20. PMID: 27086894