Transplant is recommended under the following conditions:
Failure of home parenteral nutrition characterized by:
- Impending or overt liver failure
- Thrombosis of ≥2 central veins
- Two or more episodes per year of systemic sepsis, particularly those requiring hospitalization with septic shock and fungal infections
- Frequent episodes of dehydration requiring hospitalization
Pre-transplant evaluation is extensive and most patients will meet with a multidisciplinary team that includes a transplant clinician, hepatologist, gastroenterologist, social worker, financial coordinator, nutritionist, and psychologist
Patient survival is approximately 80 percent at one year and just over 60 percent at five years. As a result of surgical advances, control of acute cellular rejection, and a decrease in lethal infections, the rate of patient survival at one year now exceeds 90 percent at experienced centers.
There are essentially 4 types of transplants involving the intestine.
- The first is the isolated intestinal transplant. This type of transplant consists of the small bowel (jejunum and ileum) and is given to patients who have normal liver function or a liver with early/reversible liver disease and meet the criteria for intestinal transplantation.
- The second type of transplant is the combined liver and intestinal transplant. This consists of two organs – the liver plus the entire small intestine together as one group. It is given to patients with irreversible liver disease and intestinal failure.
- The third type of transplant is the multivisceral transplant. This transplant includes the liver, stomach, duodenum, pancreas, and small bowel. It is reserved for patients who have organ failure involving the liver, pancreas, and intestine or for patients with diffuse diseases of their intestines (such as Gardner’s Syndrome, intestinal polyposis, or motility disorders such as pseudo-obstruction) associated with liver disease.
- The fourth option is a modification of the multivisceral transplant called the modified multivisceral transplant in which the liver is not included and the stomach may or may not be included.
The organs transplanted are tailored to the patients needs. During the transplant, your organs are removed, the new organs are placed, the blood vessels are attached and an ostomy (either an ileostomy or colostomy) is created and the skin is closed. An ostomy is an opening from inside the abdomen to the outside of the abdomen and is used for elimination of stool, as well as monitoring the new intestine for rejection. Depending on the type of intestinal failure, some ostomies are temporary and others are not. If the ostomy is temporary and the patient remains stable, the bowel can be reconnected at a later time.
Post- transplant complications:
- Technical complications can occur including bleeding, thrombosis and anastomotic leaks.
- Infectious complications (particularly bacterial infections) are common and remain the leading cause of death.
- The incidence of rejection is high in intestinal transplantation compared with other organs, although there has been some degree of improvement in recent years.
- Other complications such as GVHD and PTLD are less common.
The decision for transplant should not be taken lightly and patients should ensure that they are well informed.