Are you a candidate for intestinal transplantation?

Intestinal transplantation is a surgery to remove a diseased part of the small intestine and replace it with healthy intestine. Some patients may need the procedure to lengthen a short intestine that is too short.

The risk of the body rejecting the new intestine is high. That is why doctors reserve transplants for those who don’t have other treatment options. Based on the latest Organ Procurement and Transplantation Network data, 96 patients underwent intestinal transplants in 2021.

Doctors may perform an intestinal transplant alone, or they may also transplant another organ, such as a new liver, stomach, or pancreas.

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Who Is a Candidate for Intestinal Transplantation?

Doctors consider intestinal transplants for patients who are not doing well on total parenteral nutrition (TPN). TPN is when patients have a catheter and receive nutrients directly into the blood.

People may need intestinal transplantation if they have:

  • Had multiple TPN-related infections.
  • Low absorption of nutrients due to blocked veins.
  • Liver or other organ problems due to TPN.
  • Frequent dehydration, despite TPN and intravenous fluids.

Short bowel syndrome is the most common reason adults need TPN — and possibly an intestinal transplant. Short bowel syndrome is when a person cannot absorb enough nutrients because their small intestine is not long enough or is too damaged.

This may occur after surgery to treat Crohn’s disease, cancer, or an injury.

Many other conditions may lead to transplant. These include benign tumor growth in the intestines and disorders where the nerves or muscles in the intestine do not work properly.

What to Expect with Intestinal Transplantation

Doctors will perform several tests to see if intestinal transplant is likely to improve your life. These tests may include:

  • Blood tests.
  • Ultrasounds.
  • X-rays.
  • CT scans.
  • Tests to see how heart and lungs perform.

These tests also help the team locate a compatible donor and predict how your body will respond to the stress of transplant.

Transplants typically do not come from living donors, since removing part of the intestine can cause serious health problems for the donor. (Living donors account for less than 1% of intestinal surgeries).

If you are eligible, you will be on the waitlist until you are the first in line for a match from a deceased donor. The median wait in the U.S. is about 10 months. Some patients find a match after a couple months and others wait more than a year.

During this time, you may need to repeat some tests to ensure you remain eligible.

When you receive a call about an available transplant, the nurse will let you know what to expect. The nurse will instruct you to stop eating (or to stop or reduce TPN) and come to the hospital as soon as possible.

During surgery, you will be under general anesthesia, so you will not be conscious or feel pain. Doctors will remove the diseased part of the intestine. Then, they will attach the transplant intestine in several places.

The team will add an ileostomy, an opening that allows waste to drain into a pouch outside the body. For some people, doctors may be able to close the ileostomy in a future second surgery, assuming the transplant goes well. In this case, they would attach the small intestine to the large intestine to allow for regular bowel movements.

The entire procedure takes about eight hours — or longer if one or more other organs are being transplanted.

Recovery and Long-Term Prognosis

After surgery, you will go to the ICU for a few days. You will receive medications and fluids through an IV, while machines monitor your heart and lung functions.

You will receive immunosuppressants to prevent infection, so it doesn’t attack the new intestine. Medications include antibiotics and steroids.

Many patients spend months in the hospital post-transplant. During this time, you will continue to receive medications and monitoring. Those with intestinal transplants need to take drugs for life, including medications that suppress the immune system.

While in the hospital, you may be able to start eating and drinking soft foods and fluids. Most transplant patients can eventually stop TPN and eat a regular diet.

Statistics from the Scientific Registry of Transplant Recipients (SRTR) show that, “one year after transplantation, 83% of intestinal transplant patients are still alive and 70% are still alive at three years. Approximately 80% of these transplant recipients become free from parenteral nutrition.”

Sources

Dr. Oya Andacoglu. Instestinal Transplantation. Medscape. Link

Drs. Nicolas D. Cheesman and Jeffery B. Dattilo. Intestinal and Multivisceral Transplantation. StatPearls Link

Dr. Macey L. Henderson et al. Landscape of Living Multiorgan Donation in the United States. Transplantation. Link

Dr. Martin Hertl. Small intestine transplantation. Merck Manual. Link

National Institutes of Health. Short Bowel Syndrome. Link

U.S. Department of Health and Human Services. OPTN/SRTR 2019 Annual Data Report: Intestine. Link

About Digestive Disorders

The UPMC Digestive Disorders Center cares for a wide range of gastrointestinal (GI) conditions and diseases, from diagnosis to treatment. Whether your digestive condition is common or complicated, our experts can help. Upon referral from your physician, we coordinate your testing and treatment. If you have a complicated condition, we can refer you to one of UPMC’s digestive health centers of excellence. Find a GI doctor near you.