Intestinal Transplant (also called small bowel transplant) is a surgical procedure that replaces shortened or unhealthy small bowel donated by a healthy person. This procedure has changed over years from experiment levels to what has now become the single option for those suffering from intestinal failure. This is the only option for those people who are suffering from irreparable complications as a result of parenteral diets.
As more and more of these operations get done, more improvements have been realized in terms of results. This is due to improved issues of organ preservation, surgical methods, postoperative management and immunosuppression. Once you are through a successful bowel procedure, you will be able to live normally. However, you will need to be put into a medication plan with frequent health check-ups for life.
The total procedure longs for less than 6 months. The operation lasts for 8-10 hours. Here the patient is not required to travel at the last moment. Just a part of the small bowel will be removed from the donor and then transplanted into the patient. The patient will be called several times in short notice period.
In the United States, there are many centres from which you can get this procedure. However, you will need to travel from your home. This procedure is usually covered by insurance plans but travel expenses are not covered. You will need to plan for this.
In case you are unable to meet travel expenses, a number of charitable bodies are available to assist you in this.
If you already know where you will be going for an Intestinal transplant, or a consult or second opinion, click here to plan your travel. Otherwise, click here to get information about facilities that specialize in Intestinal transplant.
If you cannot afford travel for medical treatment, please consult our directory of charitable organizations that can help arrange no-cost transportation for you.
For more information: (links to the sections below)
- About bowel transplant operations
- Where to go for Small Bowel Procedure?
- How Small Bowel transplant is done?
- Before Bowel Operation
- Risks Involved in Small Bowel Operation
- Organ Rejection
- Who can get small bowel transplant?
About bowel transplant operations
Here are the main types of bowel transplant procedures;
- Transplant of small bowel only. This is mostly for those with bowel failure but healthy liver.
- Transplant of both small bowel and liver. This procedure is for those with both bowel problems and liver disease. Although this is not common, it is usually done to patients with multiple organ failure. This involves such transplantation of the pancreas, stomach, liver, small bowel and duodenum (the first part of small bowel).
Small bowel transplant can be performed using a part of bowel donated by a living close relative. The person donating will need to be operated on too. The part to be donated is removed and the rest sewn back in place.
Where to go for Small Bowel Procedure?
If it has been deemed necessary for you to have a small bowel transplant operation, you will be taken in for a procedure assessment. In between one to three weeks, you will undergo several texts to be sure that transplant is the only available option for you.
The circumstances that may lead to transplant decision include the following;
- You are suffering from cancer that has gone to other parts of your body.
- If you are suffering from a severe disease and you look in bad shape.
- If you must be assisted to breathe by a ventilator.
- If you are above 60 years.
- If you have ignored your doctor’s advice, for example quite smoking, you have refused to use prescribed medication or even dishonoured appointments with your doctor.
How Small Bowel transplant is done?
This operation is done under general anaesthetic taking between eight and 10 hours. Sometimes it can exceed 10 hours.
After the damaged bowel has been removed, the blood vessels are then connected to the blood vessels of the donated bowel. After this, the bowel is connected to the digestive tract or whatever section of the bowel remains. Your surgeon will then create what is called ileostomy (section of small bowel is turned through a slot in the tummy that is called a stoma).
The ileostomy is the opening that allows body waste to come out and get collected in an external pouch. The surgeon’s team then uses this to make an assessment of the success of the operation. This opening may be closed after several months and the bowel will be reconnected. However, this is not always possible.
Before Bowel Operation
In case you are in need of this procedure and you do not have someone to donate, you will be put in the national waiting list. When you are put in this list, you will need to constantly communicate any changes in your address since the medical staff can contact you in short notice as at when the organs are available.
It is possible that you can be called several times before the surgeons become sure of suitability of donated organs. So you can choose from the medical facilities that are easy for you to access.
The time spent waiting for the operation will depend on your blood group, the donor available, your position in the waiting list and how urgent your case is. In normal circumstances, this waiting time is usually under six months. A doctor will be taking care of you before and after operation.
Risks Involved in Small Bowel Operation
Just like in any other types of surgical operations, there are risks involved in small bowel transplant. However, it is good to realize that improvements in this sector have reduced these risks. Today, there are improved anti-rejection medications, improved surgical operation procedures, as well as better understanding of the immune system. These improvements have meant more number of successful operations and survival rates.
There are instances when severe complications can still be seen;
- Heart complications and breathing problems.
- Small bowel infections such as being infected by the cytomegalovirus (CMV)
- Thrombosis (blood clots)
- Post-transplant lymphoproliferativedisorder (PTLD). This is where a virus called Epstein-Barr attacks white blood cells. This infection can result in growths that are abnormal in the body as well as organ failure (multiple) if treatment is not administered on time.
- Organ rejection
- Side effects of anti-rejection drugs, increased risks of renal problems, types of cancer and other infections.
These risks and poor health of patients considered in these operations make some of them die within a few years after the operation. However, most patients, adults and children enjoy life for another five or so years.
In some instances, the patient’s immune system may attack the donated organ by making antibodies resulting in non-functioning of the donated tissues. Immunosuppressant drugs are administered during and after the operation. These drugs must be taken for life. Sometimes bacteria can enter bloodstream causing severe problems. However, no need to worry because the transplant experts will follow and monitor you closely to deal with any risks.
Who can get small bowel transplant?
Those patients suffering from bowel failure and have developed Total Parenteral Nutrition (TPN) should consider a bowel transplant. TPN refers to a situation where a patient must ingest nutrition through a drip through a vein. This is associated with the fact that the patient is unable to eat food naturally because the bowels have failed in their functions of absorbing nutrients from ingested food. This failure may also be caused by short gut/bowel syndrome.
This situation can be caused by any of the following;
- Volvulus, this is twisting of the bowel
- Gastroschisis, this is a defect occurring at birth, sometimes a baby may be born with bowels developing outside the body.
- Necrotising enterocolitis, this is when part of the bowel fails.
- Bowel cancer/Crohn’s disease, this is an operation to replace a large section of the bowels.
In majority of cases of short gut syndrome, some Parenteral nutrition is needed. This can be well managed at home. However, when TPN has been used for extended period of time, complications can result. These complications can be fatal.
Some of these complications include the following;
- You can run out of veins (suitable) for inserting the needed catheters.
- Infections can develop on the areas where the catheters are placed. This can go into the bloodstream resulting to sepsis.
- Disease of the liver