An intestinal transplant is a last-resort treatment option for patients with intestinal failure who develop life-threatening complications from total parenteral nutrition (TPN). In intestinal failure, the intestines can’t digest food or absorb the fluids, electrolytes and nutrients essential for life. Patients must receive TPN, which provides liquid nutrition through a catheter or needle inserted into a vein in the arm, groin, neck or chest. Long-term TPN can result in complications including bone disorders, catheter-related infections and liver failure. Over time, TPN also can damage veins used to administer the nutrition via the catheter.
An intestinal transplant may be appropriate if you:
- Are dependent on intravenous TPN
- Have developed infections or complications that make it increasingly difficult to administer TPN
- Have liver failure
- Don’t have a bowel, or have a nonfunctional bowel
After receiving an intestinal transplant, patients can be transitioned from TPN to an oral diet, thus improving their health and quality of life. However, it’s important to remember that an intestinal transplant is not a surgical cure, but rather a last-resort therapy that requires the meticulous administration of medication and close monitoring to be successful.
If you are referred for an intestinal transplant, you will complete an evaluation process to be sure that intestinal transplant is an appropriate treatment for you. During the evaluation process, your medical history will be recorded and you will complete a thorough medical examination and consultations with our doctors, nurses, dieticians and social workers. You also will have a variety of tests, which may include, but are not limited to:
- Upper gastrointestinal and small bowel X-ray series
- Barium enema
- Endoscopy
- Abdominal CT scan
- Motility studies
- EKG and echocardiography
- Ultrasound of the circulatory system
- Blood tests for liver function, electrolytes, kidney function and antibodies to certain viruses
- Additional tests that help determine the success of the transplant
During your evaluation period, the medical team will provide you with detailed information about intestinal transplant and what to expect after surgery. During this time, you’ll have an opportunity to discuss any questions you may have about the procedure.
You also will need to identify a friend or family member as a support person to help you after your transplant. Your support person is very important to your recovery period after you have been discharged from the hospital. They will need to stay with you during this time and accompany you to your follow-up appointments.
If you qualify for an intestinal transplant, you will be placed on the intestinal transplant waiting list. Wait time for all organ transplants depends on the availability of organs and number of people on the waiting list. Intestinal transplant recipients may wait for six months or more to receive a transplant once they are placed on the waiting list.
Care after an intestinal transplant differs slightly for each patient, depending on their medical history, type of transplant and medical condition at the time of their transplant. The length of stay in the hospital varies for each patient, but can last for several weeks or as long as several months.
After your transplant, you will be taken to the intensive care unit (ICU) where you will be closely monitored. When you are ready, you will be transferred to a recovery ward where you will be monitored and cared for by a team of transplant experts, including doctors, nurses and nurse practitioners, dieticians, pharmacists and social workers. During this time, you will have frequent blood draws, biopsies of the transplanted intestine through the ileostomy and radiologic testing. These tests will help determine the health or your transplanted organ.
You also will begin the process of weaning from total parenteral nutrition (TPN) and will slowly start feeding through your feeding tube with a liquid nutritional supplement. Over time, you will start an oral diet.
After you leave the hospital, you can expect weekly office visits, frequent biopsies of the transplanted intestine and lab work twice a week. Your support person also will need to stay with you during this time to help with your daily activities, taking you to testing and medical appointments.
After your transplant, your body will think of the transplanted organ as a “foreigner,” and therefore your immune system will try to attack it. This is called “rejection”. To help prevent rejection from occurring, you will take immunosuppressive medications, which decrease your immune systems activity so that it won’t reject your transplanted organ. The risk of rejection never goes away, so transplant recipients need to take immunosuppressive drugs for life.
Although immunosuppressive medications help reduce your risk of rejection, they also weaken your immune system, putting you at a higher risk for infections. For this reason, you will need to take medications to help prevent bacterial, fungal and viral infections. Some patients also may require blood pressure, diabetes or anti-ulcer medications.
It is important to remember that an intestinal transplant is not a surgical cure, but rather a last-resort therapy that requires meticulous administration of medication and close monitoring to be successful.
Over the last several years, success rates for intestinal transplant have improved dramatically. One-year survival rates for patients after intestinal transplant are more than 85 percent, which is comparable to liver transplant patients. Eighty percent of patients who have had an intestinal transplant are able to completely transition from total parenteral nutrition (TPN) to an oral diet and resume normal activities of daily living.
Transplant recipients face increased risks for cancer such as skin cancer and lymphoma, a side effect of some immunosuppressant drugs, and should be closely monitored for these conditions.