Small Bowel Transplant

A small bowel (intestinal) transplant is an operation to replace a diseased or shortened small bowel with a healthy bowel from a donor.
Why a small bowel transplant is needed
A small bowel transplant is an option for children and adults whose bowel has stopped working properly and who are being fed by total parenteral nutrition. Parenteral nutrition is where liquid nutrition is given through a drip. For more information see What is TPN?.
A small bowel transplant may be considered when the person has developed complications from TPN or is unable to tolerate this form of feeding. See when it is needed for more information.
How common is it?

In the UK, small bowel transplants were first performed in adults at Addenbrooke’s Hospital, Cambridge in 1987 and in children at the Children’s Hospital in Birmingham in 1993.
As of September 2009, a total of 91 bowel transplants had been performed.
University of Pittsburgh, Thomas E. Starzl Transplantation Institute provides:
isolated intestine (small bowel),
combined liver-intestine, and
multivisceral transplantation for patients who have irreversible intestinal failure.
The program has performed more than 450 intestinal and multivisceral transplants which represents more than one-third of the total number of adult transplants worldwide.

Utilizing innovative immunosuppressive protocols, the patient survival has always been above the international average with:

Utilizing innovative immunosuppressive protocols, the patient survival has always been above the international average with:
survival at one year

96%

survival at three year

90%

survival at four year

82%

PRESENT

Outlook

After receiving a small bowel transplant, patients can be moved from total parenteral nutrition to a normal diet fed through the mouth.
However, a transplant is complicated and difficult surgery that can take up to 12 hours. In the past, there were high rates of rejection of the new organ, but the introduction of more advanced immunosuppressant drugs over the last 15 years has greatly improved survival rates.
Immunosuppressant drugs (which weaken your immune system) are given during and after your transplant and must be taken for life, so your body will not reject your new bowel.
You will need to have regular blood tests and will be routinely seen at the transplant centre for the rest of your life

Why do I need a small bowel transplant?

Most patients with short gut syndrome (where there is not enough bowel to absorb nutrients) will need some parenteral nutrition (feeding via a catheter) and will be able to manage well.
However, if complications from parenteral nutrition develop, or if the person can no longer tolerate this form of feeding, then a small bowel transplant may be considered.
Complications can include:
liver disease infection of the intravenous line (drip), which can spread through the bloodstream
problems with venous access (a device fitted under the skin to allow access to the bloodstream without repeatedly puncturing the blood vessels);
A combined liver and small bowel transplant or multiple organ transplant (multivisceral transplant) is performed on patients who have developed liver disease or who have large tumors that can only be removed by transplanting several organs.
Underlying diseases
Small bowel transplant patients may have either a tumor or short gut syndrome. Short gut syndrome can be caused by:
volvulus (twisting of the bowel)
gastroschisis (a birth defect where some of a baby’s bowel develops outside the body)
necrotising enterocolitis (where part of the tissue of the bowel dies)
Crohn’s disease an injury

What is TPN?

Total parenteral nutrition, or TPN, provides liquid nutrition through a catheter (fine tube) that is inserted into a vein in the arm, groin, neck or chest. It is often given overnight.
Long-term TPN may be recommended for children, although it can result in complications including liver disease, bone disorders or catheter-related infections. TPN can also damage the veins used to administer the nutrition.
TPN is the only alternative to a small bowel transplant

What happens in a small bowel transplant?

A small bowel transplant is complicated surgery and can take up to 12 hours.
Depending on the cause of your bowel failure, it may be recommended that you have one of the following:
Small bowel transplant, which is recommended for patients with bowel failure who do not have liver disease.
Combined liver and small bowel transplant, which is recommended for patients with bowel failure who also have end-stage liver disease.
Multivisceral (multiple organ) transplant, which is not a commonly performed operation, but may be recommended for patients with multiple organ failure. The diseased stomach, pancreas, duodenum, liver and small bowel are removed and healthy donor organs transplanted
Risks of small bowel transplant
Better anti-rejection drugs, refined surgical procedures and a greater understanding of the body’s immune system have increased the number of successful bowel transplants and improved survival rates.
However, complications can include:
rejection of the donor organ (see below)
infection
Also, taking immunosuppressant medication can make certain types of cancer more likely.

What is rejection?

Rejection is a normal reaction of the body. When a new organ is transplanted, your body’s immune system sees it as a threat and makes antibodies against it, which can stop it from working properly.
Immunosuppressant drugs (which weaken your immune system) are given during and after your transplant and must be taken for life, so your body will not reject your new bowel.
If rejection does happen, there is a risk that the bacteria found in the small bowel can get into your bloodstream.
After surgery you will be closely monitored by the transplant team to reduce this risk

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