Intestinal Transplant Q & A\u00a0with Ruy Cruz, Jr., MD, PhD\nSurgical Director, UPMC Intestinal Rehabilitation and Transplantation Center\nSome transplant surgeries are straightforward with regards to candidate selection. If you need a new kidney, you get a new kidney; if you need a new heart, you get a new heart. But intestinal transplantation is a bit more ambiguous. The intestine is part of the extremely complex digestive system, but it\u2019s not exactly an organ.\nHow Do Intestinal Transplants Work?\n\u201cThere\u2019s no simple answer for that question,\u201d says Dr. Ruy Cruz, surgical director of UPMC\u2019s Intestinal Rehabilitation and Transplantation Center. \u201cThere\u2019s no protocol for intestinal transplant surgery, because it\u2019s simply not as straightforward as the heart or the kidney. It all depends on the individual patient\u2019s situation.\u201d\nDr. Cruz is comfortable with ambiguity. Some of his patients come to him in need of small bowel replacement. Others require multiple organ transplants to restore optimal function to the intestine. Some are candidates for intestinal rehabilitation. What they do share, however, is a dependence on TPN, or total parenteral nutrition.\nThis adequate but imperfect nutrient delivery strategy may feed the body, but it does not feed the soul. Being able to eat with family and friends is an important part of everyday life. Fixing the intestine can restore a measure of normality. Dr. Cruz is willing to figure out how to make that happen, and he starts from scratch every time.\n\u201cBy the time they come to us, most of our patients have already had six or seven different operations,\u201d says Dr. Cruz. \u201cWe are their last stop.\u201d The multidisciplinary team takes care to evaluate each patient\u2019s status from every perspective in order to determine the best course of action, always with the goal of discontinuing or minimizing TPN. \u201cThere\u2019s no recipe for the progression of care; it always begins with the patient\u2019s baseline disease and builds from there. It\u2019s complex.\u201d\nAn unusual aspect of Dr. Cruz\u2019s practice is that not every patient he sees actually requires intestinal transplant surgery. Some patients benefit from intestinal rehabilitation, which can be medical or surgical and usually includes nutrition management.\nIn every case, early referral is the most important consideration. \u201cThe sooner we see the patient, the sooner we can take action. Ideally, we can intervene before pancreatic or liver disease becomes an additional cause for concern,\u201d says Dr. Cruz.\nTo learn more about the latest developments in the field, visit the UPMC Intestinal Rehabilitation and Transplantation Center.