Our Summary

In 2001, a report was published discussing when a patient with severe intestinal issues would need an intestinal transplant. Since then, medical advancements have improved how we handle such cases, including the transplant process and patient survival rates. As a result, the number of intestinal transplants has decreased from a high of 270 per year in 2008 to 149 per year in 2017. This suggests that the guidelines from the 2001 report need to be updated.

Now it is suggested that all patients with serious intestinal issues should be managed by a team of specialized doctors. These patients might need to consider a transplant if their intestinal disease starts affecting their liver, if they start losing access to central veins, or if they repeatedly get dangerous infections related to the tubes used for their treatment. Other reasons to consider a transplant include having large tumors in the stomach area, severe vein blockages leading to tissue death, certain congenital conditions, and severe, unmanageable diarrhea.

Life quality generally improves after a successful intestinal transplant and can be a factor when deciding to proceed with the operation. However, the need for lifelong medication to suppress the immune system and its associated side effects means that patients should not consider a transplant solely for the purpose of improving their quality of life. As our experience with intestinal transplants grows and we continue to evaluate how they affect patient survival and life quality, along with potential improvements in medication, we expect to see changes in how we approach these transplants in the future.

FAQs

  1. What are the indications for considering an intestinal transplant?
  2. How has the management of intestinal failure and patient survival improved since 2001?
  3. What are the potential drawbacks of undergoing an intestinal transplant?

Doctor’s Tip

One helpful tip a doctor might tell a patient about intestinal transplant is to make sure to follow all post-transplant care instructions, including taking immunosuppressive medications as prescribed. It is important to attend all follow-up appointments and communicate any changes in symptoms or concerns to your healthcare team. By following these guidelines, you can help ensure the success of your intestinal transplant and improve your quality of life.

Suitable For

Patients typically recommended for intestinal transplant include those with permanent intestinal failure who are unable to tolerate or absorb nutrients adequately, leading to dependence on parenteral nutrition. Specific indications for transplantation include progressive intestinal failure-associated liver disease, progressive loss of central vein access, repeated life-threatening central venous catheter-associated infections, large desmoid tumors or other intra-abdominal tumors, extensive mesenteric vein thrombosis and intestinal infarction, total intestinal aganglionosis, and nonrecoverable congenital secretory diarrhea.

Patients with these conditions may benefit from intestinal transplantation as it can improve quality of life and potentially cure underlying conditions. However, the decision to proceed with transplantation should be carefully considered and weighed against the risks of lifelong immunosuppression and associated side effects. A multidisciplinary team specializing in intestinal rehabilitation should be involved in the evaluation and management of these patients to determine the most appropriate treatment approach.

Timeline

Before intestinal transplant:

  • Patient experiences progressive intestinal failure
  • Patient may develop complications such as intestinal failure-associated liver disease, loss of central vein access, and central venous catheter-associated infections
  • Patient may be managed by a dedicated multidisciplinary intestinal rehabilitation team
  • Patient may be considered for intestinal transplant based on specific indications such as extensive mesenteric vein thrombosis, total intestinal aganglionosis, and nonrecoverable congenital secretory diarrhea

After intestinal transplant:

  • Patient undergoes the transplant surgery
  • Patient requires life-long immunosuppression to prevent rejection of the transplanted organ
  • Patient may experience improvements in quality of life post-transplant
  • Patient may need to be closely monitored for potential complications and side effects of immunosuppressive medications
  • Patient may have a reduced need for parenteral nutrition and experience improved overall health and well-being

What to Ask Your Doctor

  1. What are the potential risks and complications associated with intestinal transplantation?
  2. How long is the recovery process after receiving an intestinal transplant?
  3. What is the success rate for intestinal transplants in patients with my specific condition?
  4. How will I need to adjust my lifestyle and diet post-transplant?
  5. What medications will I need to take post-transplant and what are the potential side effects?
  6. How often will I need to follow up with my transplant team after the procedure?
  7. What is the long-term outlook for patients who receive an intestinal transplant?
  8. Are there any alternative treatments or therapies that I should consider before proceeding with a transplant?
  9. How will receiving an intestinal transplant impact my overall health and well-being?
  10. What is the availability of support services for transplant recipients, such as counseling or rehabilitation programs?

Reference

Authors: Kaufman SS, Avitzur Y, Beath SV, Ceulemans LJ, Gondolesi GE, Mazariegos GV, Pironi L. Journal: Transplantation. 2020 May;104(5):937-946. doi: 10.1097/TP.0000000000003065. PMID: 31815899