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Small Intestine Transplantation

By Martin Hertl, MD, PhD, Jack Fraser Smith Professor of Surgery, Director of Solid Organ Transplantation, and Chief Surgical Officer, Rush University Medical Center

Transplantation of the small intestine may be done when people cannot get enough nutrients because

  • They have a severe disorder that prevents the intestine from absorbing nutrients.

  • The intestine had to be removed because of a disorder or injury.

  • They have a tumor, abscess, or another problem that is blocking the intestine

  • They need to be fed intravenously (total parenteral nutrition) but can no longer can be because of problems, such as liver failure or recurring infections.

Small intestine transplantations are being done less frequently because there are new treatments and techniques that make transplantation less necessary.

After 3 years, more than 50% of small intestine transplants are still functioning, and about 65% of people who have had an intestinal transplant are still alive.

Procedure

The small intestine can be transplanted alone or with other organs—a liver, stomach, duodenum, and/or pancreas. These procedures can be very complicated.

A surgeon removes the diseased part of the recipient's small intestine and replaces it with a healthy piece of small intestine from the donor. The blood vessels of the recipient and the transplant are connected, and the donor's intestine is connected to the recipient's digestive tract.

Part of the transplanted small intestine is connected to an opening through the abdominal wall to the skin—called an ileostomy. This opening enables doctors to monitor how well the transplant is functioning and to check for problems. Usually, the opening can be closed after a period of time. While the ileostomy is present, body wastes pass through it and empty into a pouch.

Complications

Transplantation can cause various complications. Intestinal transplants are particularly prone to both infection and rejection.

Rejection

Rejection occurs at least once in about 30 to 50% of people within a year after small intestine transplantation. Symptoms include diarrhea, fever, and abdominal cramps.

After transplantation, doctors use a viewing tube (endoscope) to check the intestine for signs of rejection. This test is done frequently, sometimes once a week, at first. Then the test is done every few weeks, then every few months.

Graft-versus-host disease

Because the small intestine contains a large amount of lymphatic tissue, the new intestinal tissue may produce cells that attack the recipient’s cells, causing graft-versus-host disease.