Intestine Transplant

An intestine transplant replaces a damaged or shortened small bowel with a healthy one from a donor. The small intestine runs to around twenty feet and is where almost all nutrient absorption happens, so when enough of it is lost or stops working, food alone can no longer sustain the body. That state is called intestinal failure, and short bowel syndrome — too little functioning intestine left — is its commonest form.

How intestinal failure arises

Bowel that has twisted and lost its blood supply, bowel removed for Crohn's disease or for cancer, and bowel a child was born without are the usual routes. Others include chronic idiopathic intestinal pseudo-obstruction, in which the bowel is present but does not move; small bowel tumours; congenital malformations; severe gastrointestinal infection; and gastroschisis in newborns, where the intestine develops outside the abdominal wall.

Why feeding through a vein eventually forces the decision

Total parenteral nutrition delivers fluid and nutrition through a drip straight into a vein, bypassing the gut entirely. It keeps people alive, sometimes for years. But prolonged use causes its own harm — liver disease, bone disease, and repeated infections of the central venous catheter that carries it. Transplantation is usually considered not when the bowel fails, but when the treatment for that failure starts to fail too.

Three operations under one name

An isolated small bowel transplant replaces the intestine alone, and is used where the liver is still healthy. A combined liver-intestine transplant replaces both, and is needed where parenteral nutrition has already damaged the liver. A multivisceral transplant replaces several abdominal organs together — stomach, duodenum, pancreas, intestine and often liver — where failure is not confined to one of them. The operation takes eight to ten hours. The surgeon removes the diseased bowel, joins the blood vessels of the new intestine, and connects it to the digestive tract. An ileostomy is usually formed: an opening on the abdominal wall through which bowel content passes into a bag. It is not permanent, and it exists for a specific reason — it allows the transplanted bowel to be looked at directly and biopsied, which is how rejection is caught early. It is usually closed some months later.

Rejection, and the thing that makes this transplant different

Immunosuppressant medication is lifelong. The intestine carries a large amount of immune tissue of its own, which is why two things can happen rather than one: the body can reject the intestine, and the intestine's immune cells can attack the recipient — graft-versus-host disease — sometimes months or years later. Hospital stay after an uncomplicated transplant is around a week to ten days, with recovery over the following weeks, but complication is common enough that planning for the shorter figure would be unwise. Ask before you travel who will manage the immunosuppression, the nutrition and the stoma once you are home.