Everything you need to know about small intestine transplant

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Did you know, that a large number of people require intestinal transplants? The intestines may fail to sufficiently process and absorb food, thus failing to meet the body's nutritional needs. This condition is known as intestinal failure.

Dr Gaurav Chaubal, Director of Liver, Pancreas, Intestine Transplant Program and HPB Surgery, Global Hospitals, Parel sheds light on the importance of small intestine transplants.

A surgical procedure, the small bowel transplant, involves transferring small intestines from a living or deceased donor to a recipient. This transplant might be necessary for individuals with certain congenital conditions. In children, these conditions include necrotising enterocolitis, malabsorption syndromes, and motility disorders.

On the other hand, adults might need this procedure due to mesenteric ischemia, volvulus, or invasive mesenteric tumours. These patients typically experience malnutrition and progressive weight loss. To manage these symptoms, they often need artificial nutrition which is costly and can lead to severe complications such as potentially fatal infections.

Types of intestinal transplant
For patients suffering from intestinal failure, the preferred method of treatment is an intestinal transplant. This involves the surgical removal of the unhealthy section of the small intestine and replacing it with a healthy one from a donor. In cases where the disease is confined only to the small intestine without any liver failure, this procedure can be a vital lifeline for patients whose condition has become critical due to irreversible intestinal failure.

On the other hand, when both liver and intestines fail, combined liver and intestine transplantation is performed. Here, both diseased organs are surgically removed and replaced with healthy ones from a donor. The primary reason for liver failure in these instances is complications arising from intravenous nutrition or TPN. Without undergoing transplantation, patients suffering from both intestinal and liver failures while continuing on TPN are generally expected to survive between 6 to 12 months.

When two or more internal abdominal organs, including the intestines, are failing, a multivisceral transplantation is carried out. The procedure might involve transplanting organs such as the stomach, duodenum, pancreas, intestine, and liver. This intricate operation can be lifesaving for individuals suffering from combined abdominal organ failure due to diseases like Gardner's syndrome (familial colorectal polyposis), a precancerous colorectal disorder, and intestinal pseudo-obstruction (a reduced capacity of the intestines to move food along).

The recuperation period post-transplant typically spans two to three weeks. Following the transplant, patients can resume normal life activities and dietary habits. A successful outcome is achieved in seventy-five per cent of patients who can eventually stop relying on artificial nutrition.

Types of tests done before the transplant

Blood group and HLA typing.

Laboratory tests: Automated blood count (CBC), hepatic and renal function tests, coagulation profile.

Serologic tests: CMV, EBV, HIV, as well as hepatitis A, B, and C

Radiographic evaluation of the entire gastrointestinal tract to determine actual bowel length and function (transit time)

Duplex Doppler sonography of the intraabdominal vascular system (abdominal aorta, superior mesenteric artery, portal vein, superior mesenteric vein). Conventional angiography is not routinely done and is only required for selected patients.

Liver biopsy (only for patients with clinical evidence for total parenteral nutrition-induced liver dysfunction to assess the need for a simultaneous liver transplant)

Assessment for the presence of infectious foci (including dental and ENT consults)

Additional organ system-specific investigations as dictated by pathology results of the aforementioned evaluation process (e.g., coronary angiography, pulmonary function tests, creatinine clearance).

Screening before transplantation is a process that both donors and recipients must go through. The purpose of this screening is to confirm the organ's suitability for transplantation by ensuring it is healthy. Additionally, it checks if the recipient has any medical issues that would prevent them from undergoing a transplant.

The transplant procedure
The transplantation of the small intestine can occur independently or in conjunction with other organs such as the liver, stomach, or pancreas. This surgical process can be quite intricate. The procedure involves a surgeon extracting the unhealthy portion of the recipient's small intestine and substituting it with a healthy segment from a donor. The blood vessels of both parties are then interconnected, and the donor's intestinal piece is linked to the recipient's digestive system.

A section of the transplanted intestine is attached to an ileostomy which is an opening leading from the abdominal wall to the skin. This allows for the assessment of transplant functionality and the detection of potential issues. Over time, this opening may typically be sealed up. As long as this ileostomy exists, bodily waste is expelled through it into a pouch.

Disclaimer: This information does not replace professional medical advice. Consult a qualified specialist or your physician for personalised guidance.