What is Intestine Transplant?
The intestine or Intestinal Transplantation also referred to as Small Bowel Transplantation, is a surgical procedure to replace the small intestine for chronic and acute cases of intestinal failure. While intestinal failure can be treated often with alternative therapies like parenteral nutrition; complications linked to short bowel syndrome and liver diseases can make transplantation the only viable option. The rarest type of organ transplantation performed, intestine transplantation is becoming increasingly prevalent as a therapeutic option due to improvements in immunosuppressive regimens, surgical technique, Parenteral Nutrition and Clinical management of pre and post-transplant patients.
What is the Small Intestine?
The small intestine is approximately seven to eight feet long in newborn infants and can grow close to 20 feet by adulthood. The Small intestine comprises of three parts:
- Duodenum: It is the first part of the small intestine which is around 12 inches long in adults and is connected to the stomach. Fluids from the liver (bile) and pancreas drain into the duodenum and digest starches, proteins and fats from the diet.
- Jejunum: It is the middle portion of the small intestine that makes up around half of the small intestine. It absorbs water and nutrients from foods.
- Ileum: It is the distal small intestine and this has specialized functions such as the production of certain hormones and proteins.
Who is eligible for Intestine Transplant?
Individuals suffering from small intestine failure are eligible for Intestine Transplant. Failure of the small intestine would be life-threatening due to the inability to absorb nutrients, fluids, and electrolytes from food. Certain conditions, such as severe inflammation, ulceration, bowel obstruction, fistulation, perforation, Crohn’s disease may severely compromise intestinal function.
What is Intestinal Failure?
The small intestine is the most critical part of the digestive system for absorption. Most people can live without a stomach or large intestine, but it is harder to live without a small intestine due to the inability to absorb the nutrients from your diet. When all or most of the small intestine is functionally impaired or if it needs to be removed, life can be extended by providing nutrients delivered intravenously (directly into the bloodstream through veins) in liquid form. These nutrients are called ‘total parenteral nutrition’ (TPN). When an individual has an irreversible intestinal failure, he/she may require TPN to survive.
What causes Intestinal Failure?
There are two types of intestinal failure:
- The length of the small intestine may be insufficient to absorb food and water adequately. This is referred to as ‘short bowel syndrome’.
- Small intestine or other parts of the digestive tract are not functioning right. This may be due to failure of intestinal motility, the movement that propulses food through the intestine, or due to malabsorption (secretory diarrhea), or the inability of cells (lining the intestine) to absorb properly.
When the intestine is too short, an individual may have a lot of bowel movements as he/she may not absorb enough nutrients and may lose too much fluid, leading to dehydration. TPN can provide both fluid volumes including the fulfillment of caloric needs of the body. While older children and adults suffer from intestinal failure for some reasons, infants can have an intestinal failure for different reasons.
What are the types of Intestine Transplant?
There are 3 major types of Intestine Transplant:
- An isolated Intestine Transplant (Part of intestine is transplanted such as – jejunum, ileum, etc.)
- A combined Intestinal-Liver Graft (Liver and Intestine transplant are performed together due to severe liver dysfunction usually due to total parenteral nutrition)
- A Multivisceral Graft (stomach, duodenum, pancreas, colon, etc. are transplanted together)
How Long Does Intestinal Transplant Surgery Take?
On average, Intestinal Transplant surgery lasts eight to ten hours. However, the length of surgery also depends on the type of intestinal transplant a patient is undergoing. Each case will be different.
While small bowel transplant surgery generally takes about 8 hours, multi-visceral transplant surgery may take 12 hours or more.
How long should a patient stay in the hospital after Intestinal Transplant?
After surgery, the patient is shifted to the Transplant Intensive Care Unit (ICU). Most of the patients spend about one to four days in the ICU. The patient will be on anti-rejection medications right away. This is because the immune system of the human body starts working to fight anything new, viewing it as a threat. Anti-rejection medications suppress the natural response of the immune system to allow the body to accept the new intestine.
The patient will also be on a feeding tube for a slow transition to a regular diet. While in the ICU, the patient will be closely monitored by the intestinal transplant team. They will keep a close watch on the patient’s condition to:
- Wean the patient off the ventilator
- Monitor for organ rejection or infection
- Adjust the patient’s anti-rejection medications
Once stable, the patient will be moved to a patient room. The patient is expected to spend three to four weeks in the hospital post-transplant surgery.
What is a Waiting List?
Potential recipients are placed on the organ waiting list. Before a transplant surgery, an organ must first be found. A major challenge for intestine transplant is the availability of transplantable intestines.
A team of surgeons, anesthetists, gastroenterologistscomprise the intestine transplant team. Once the evaluation of the recipient is complete and is kept on a waiting list for a suitable organ, the team takes up the case for transplant once they find the matching of donor’s intestine.
Conclusion
Intestinal transplant outcomes have improved significantly in recent years. The success rate in the intestine transplant is over 90 percent, whereas the most complicated case’s success rate may vary from 70 percent to 80 percent.
