The Intestine transplant has been the most challenging, delicate and least frequently performed vascularized intraabdominal organ transplant. Hence, in the course of a decade, the intestine transplant outcomes have significantly improved and increased at almost double the speed. The procedure has evolved as the last resort for the patient suffering intestinal failure who have developed irreversible complications associated with the long-term use of parental nutrition. In this case, most of the intestinal diseases are oftentimes treated with Total Parental Nutrition (TPN) that may cause liver diseases, bone disorders, central venous catheter infections and short bowel syndrome, thus, opting for transplantation becomes the only possible treatment to cure the patient when the complication TNP becomes life-threatening.

Causes of Intestine failure

Short Bowel Syndrome is the most influential cause of intestine failure which requires the removal of at least half and two-third part of the entire intestine. Pediatric and adult causes that are related to functional disorders of intestines such as Crohn’s disease, a digestive disorder, or chronic idiopathic intestinal pseudo-obstruction syndrome. Such causes that lead to intestinal dysfunction are age-dependent.

Pediatric conditions causing intestinal failure

• Congenital malformations such as small bowel atresia, gastroschisis, aganglionosis
• Gastrointestinal tract Infection like necrotizing enter colitis
• Short bowel syndrome following extensive bowel surgeries secondary to mesenteric ischemia (e.g., midgut volvulus)
• Absorptive impairment (e.g., intestinal pseudo-obstruction, microvillus inclusion disease)

Adult Conditions Causing Intestinal Failure

• Short bowel syndrome following extensive surgeries secondary to mesenteric ischemia (following thrombosis, embolism, volvulus, or trauma)
• Inflammatory bowel disease such as Crohn’s disease
• Small bowel tumors such as Gardner’s syndrome (familial colorectal polyposis)
• Tumors of the mesenteric root and retroperitoneum (desmoid tumor)

However, Intestinal transplant is the surgical procedure of replacing small intestine for chronic and acute cases of intestinal failure. Due to the improvement in immunosuppressive regiments, surgical techniques, PN and Clinical management of pre and post transplant of patients, the Intestine transplant is gaining its share of popularity throughout the world.

Evaluation process of the patient

The social, psychological and medical evaluation phase of Intestinal transplant usually requires more than two weeks depending on the medical urgency of the patient. Patient will be educated regarding the transplant process, failure risks, listing criteria and patient’s responsibilities for post-operative care in order to allow the patient fully aware of the gravity of the transplant. Patient’s consent and full cooperation are mandatory before putting him on the waiting list of donor intestine. Later, the patient will be informed about related risks, possible complications, and benefits of the surgery, based on the evaluation outcomes by the Intestinal Transplant surgeon.

Anesthesia

Anesthesia consultant will examine the patient’s response to general anesthesia and provide the safe administration of anesthesia during the surgery. After concluding these evaluations, patient will be approved and listed for the transplant by the selection committee and then, you will begin your waiting period for donor’s intestine and can be called for surgery at any moment.

Donor

To successfully operate Intestinal and multivisceral transplant, a healthy organ received from a recently deceased donor who died of brain injury and consented to organ donation.

Surgical Procedure

Before going to the operation room, the procedure begins with a preoperative testing including chest x-ray, EKG, and comprehensive lab work. Once the tests are done, you will be directly transferred to the operating table, placed on the breathing machine (ventilator) and a general anesthesia will be given to you to make you unconscious for the surgery. An incision will be made in your abdomen by the surgeon, through which the diseased intestine will be removed and a healthy donated organ will be placed instead. Based upon your conditions for intestinal transplant, a surgical technique called veno-veno may be required to allow your blood to bypass part of your upper abdomen during surgery by placing a catheter in your underarm, neck or groin and connecting the catheter to the machine.

Post-operative care

After surgery, your recovery will be closely monitored in the intensive care unit. Once your conditions become stable, you will be transferred to the transplant floor where you will be informed about the post-operative care, even your family will be allowed to stay with you as per the hospital regulations.