Intestine Transplant

Intestine is a kind of tube that runs from the stomach to the anus and absorbs water and nutrients. It comprises of three parts – small intestine, large intestine and rectum. Inability of small intestine to absorb fluids, electrolytes and nutrients from food is a highly alarming situation that can be life threatening. This is a condition when intestine transplant is advised by specialists.

Intestine transplant is also known as small bowel transplant. Through it, acute cases of intestinal failure are treated by surgical replacement of the small intestine. It is considered to be one of the rarest forms of organ transplantation. Only when alternative therapies like Parenteral Nutrition (PN) or Surgical bowel lengthening have not been effective; this surgical procedure gets advised to the patients by gastroenterology doctors.

Intestine transplant is preferred over other medical conditions due to the shortcomings present in alternative therapies.

Causes of Intestine Transplant

A combination of metabolic, infectious, traumatic and nutritional complications have a negative impact on physiology and anatomy of the small intestine leading to intestine transplant. Apart from this, there are also some congenital or genetic factors leading to intestine transplant. Medical conditions like ulceration, fistulation, severe inflammation, perforation, Crohn’s disease, volvulus, tumors, gastroschisis, mesenteric ischemia, necrotizing enterocolitis, motility disorder etc. might make intestine transplant an only option; but short bowel syndrome is the most common medical condition that results in transplantation of intestine. Short Bowel Syndrome occurs after the surgery for treatment of medical conditions like necrotizing enterocolitis and trauma.

Adult vs. Pediatric Causes

Conditions leading to intestinal failure are dependent on age. Some of the conditions mostly occur in adults and some in children only.

Adult Conditions leading to Intestinal Failure

  • Short bowel syndrome that develops after extensive surgeries
  • Inflammatory bowel diseases like Crohn’s disease
  • Small bowel tumors like Gardner’s syndrome
  • Tumors of retroperitoneum and mesenteric root

Pediatric conditions leading to Intestinal failure

  • Congenital malformations like aganglionosis, small bowel atresia, gastroschisis
  • Impairment in absorption (microvillus inclusion disease, intestinal pseudo-obstruction)
  • Infections related to gastrointestinal tract
  • Short bowel syndrome following bowel surgeries like midgut volvulus

Why Intestine Transplant gets Preferred over Parenteral Nutrition (PN)

When there is loss of intestinal function, nutrients are obtained by individuals intravenously through a procedure called PN. It is a process in which nutrition in liquid form is provided through a needle or catheter that is inserted either through veins of the chest, neck, groin or arm. Though PN can be performed at home and the individual is able to get all nutrients, fluid and energy through this procedure, the quality of life gets severely hampered. It takes somewhere between 10 to 24 hours to administer PN. This means the needle or catheter remains attached to the body continuously for this time frame. Also, this therapy has side effects like dehydration, catheter related infections, bone disorders and liver diseases.

Why Intestine Transplant gets Preferred over Surgical Bowel Lengthening

Surgical bowel lengthening is done through two procedures – serial transverse enteroplasty and longitudinal intestinal lengthening. These lengthening procedures have complications like intestinal necrosis, redilation of bowel and staple line perforation. Moreover, some individuals who have undergone this procedure might have to be dependent lifelong on PN even after the remedial steps are taken. This why it is not a preferred therapy.

Indications of Intestine Transplant

  • PN associated liver disease
  • Extremely low quality of life due to PN
  • Multiple occurrences of catheter associated sepsis
  • Loss of two or more of the six major routes to venous access
  • If the development and growth of pediatric patient does not ensue
  • Abnormalities related to fluid and electrolyte administering in the maximal medical therapy

Types of Transplant

  • Isolated Intestinal Graft – Only sections of ileum and jejunum is transplanted
  • Combined Intestinal Liver Graft – When there is severe liver dysfunction due to PN or deficiencies in enzyme; then liver and small intestine are both part of the graft.
  • Multivisceral Graft – When other abdominal organs (stomach, colon, pancreas and / or duodenum) are part of the graft. It is also considered when there is risk from extensive venous thrombosis, arterial ischemia of the mesentery, motility syndromes and other intra-abdominal tumors that have not yet metasized.

Donor – Recipient Compatibility Requirements

  • Like other organs, donated intestine should match the recipient in terms of age of donor, size of donor organ, tissue quality and histo-compatibility. Young or small patients should not be recipients of large intestines else their bodies would reject it leading to total failure of the surgery done
  • Donor weight should be ideally lesser than recipient weight so that there is easy closure of the abdominal wound

Transplantation Procedure

  • Before the Isolated Intestinal Graft, any abdominal scar tissue that may be there from other surgeries is removed.
  • The donor organ is transplanted in the recipient’s body
  • Anastomosis is done to revascularize the graft.
  • The graft is reperfused with blood.
  • Ends of the transplanted organ are connected to the original digestive tract.
  • A loop ileostomy is created for ease of biopsies and endoscopic observations in future.
  • Before closing the abdominal wall, jejunostomy or gastronomy feeding tube is placed.

In combined intestinal liver graft , liver is first transplanted and then intestine is reconstructed following the procedure of Isolated Intestinal Graft.

Of the three types of transplant, multivisceral transplant is more complex because too many organs are involved that require to survive a conjoined process of transplantation.

Post-operative Care

  • After the surgery the patient is monitored in intensive care unit (ICU).
  • A feeding tube is connected to jejunum or stomach for fast rehabilitation.
  • Bleeding is monitored and lactate as well as serum pH levels are measured.
  • Broad spectrum antibiotics as per individual needs of the patients are administered.
  • Other medications as required by individual condition are administered.
  • Preventive care is take to keep CMV and fungal infections at bay.
  • Routine surveillance is done through biopsies and endoscopy.
  • This continues until the patient has completely recovered from surgery and has started leading a healthy life.
  • PN is administered even after sometime of surgery.

All patients with successful intestine transplant do not require PN within a year of the surgery and return back to their old quality of life. Jiyo India ensures that best gastroenterologist and intestine transplant specialists of India is at your service during your diagnosis, preoperative, surgical and post operative procedures. Just call +91-8750033334 and talk to experts and get FREE advice related to surgical and hospitalization costs across the Delhi / NCR region so that you are able to take a completely informed decision regarding your or your loved ones intestine transplant.

MISSED CALL +91 93306 93306
CALL US +91-120-4333433