Importance of Intestine and What is Intestine Transplant

‘You are what you eat.’ As clearly expressed by this age old adage, the human body truly is what it consumes and this process is primarily controlled by the digestive system. Digestion is done by breaking down the food and water that is consumed by the body into single molecules. These molecules are then absorbed by the small intestine. This process provides essential elements such as vitamins, carbohydrates and amino acids to the body. As a matter of fact, around 90% of absorption of nutrients and minerals from food is done by the small intestine. However sometimes, due to an injury or certain health problems and complications, a person may suffer from intestinal failure. This is marked by the intestine’s sudden/ gradual inability to digest food and absorb fluids and nutrients essential for growth and healthy living.

Intestinal transplant is a surgical procedure that aims to resolve intestinal failure as well as other complications related to parenteral nutrition (PN).  It may be detected at birth or during its development over time.

Total Parenteral Nutrition (TPN)

The human body needs nutrients for the normal functioning of the rest of its organs. If they can’t be received due to intestinal failure, there are taken in intravenously through total parenteral nutrition wherein a catheter is inserted in the neck, arm, chest or groin area of the patient. Since continuous use of a catheter involves increased possibility of infections, bone dislocation and liver diseases, an intestinal transplant becomes the only long term solution for intestinal failure.

Eligibility for Intestine Transplant

As mentioned above, intestinal failure may happen at birth or at a later stage. Intestine transplant may be needed in the case of:

• Short gut syndrome

• Complications arising from TPN. These include inability to find additional undamaged veins to insert the catheter, movement of bones due to continued insertion and, infection

• Liver complications

A patient is also expected to undergo certain tests such as endoscopy and CT scan of the abdomen to determine his/her body health and in turn, eligibility.
 A patient may be rejected if he/she:

• Has a serious illness and/or cancer

• Is not dedicated to receiving treatment and getting better

• Is beyond 60 years of age

Types of Intestine Transplants

Basis results received from the above evaluation, a patient is recommended to undergo either one of the following transplants:

• Intestine only

• Modified multi-visceral transplant including all organs except the liver

• Combined liver and intestine with pancreas transplant

• Full multi-visceral transplant including the stomach, duodenum, pancreas, intestine and liver

Multi-visceral transplants are considered when the underlying condition significantly compromises other sections of the digestive system as listed above.

How is Intestine Transplant performed?

Intestinal grafts that are used in a transplant surgery are often sourced from a deceased donor. In case of bowel transplant, a part of the bowel can be donated by a living donor.

After the damaged parts of the patient’s intestine are removed, the procured grafts are attached to the relevant organs. Generally, a small temporary opening is also created in the lower part of the small intestine. This procedure gives the transplant team easy access to the new intestine through the stoma and helps monitor for signs of rejection.

Post-surgery care

It should be noted that an intestinal transplant is one of the most difficult transplant procedures. Scar tissues from a previous surgery make it hard to replace the damaged intestine and may also result into a large amount of bleeding.

A huge concern post-surgery is organ rejection. Anti-rejection drugs are given to prevent this because the immune system naturally tends to attack a transplanted organ as if it were a dangerous virus. A patient is also given intravenous fluids to help healing along with antibiotics and antiviral drugs to reduce the chance of infection. A patient is allowed to eat within 2 to 4 weeks from the transplant surgery. Although TPN is generally avoided, it may be needed for some patients until they begun to eat well. Apart from this, regular bowel biopsies or an endoscopy may be scheduled to examine the progress and to determine if any additional medication is needed.

Also, as is the case for any other transplant, not enough emphasis can be drawn to the importance of taking medications as prescribed. Failure to do so may significantly increase the risk of infections and other complications.

As there is no direct way to understand if the transplant surgery has been a success or not, some symptoms that a patient and his/her family should look out for include:

• Nausea and vomiting

• Blood in stools

• Swelling or change in appearance of stoma

• Loss of appetite

Why FORTIS?

Fortis has an integrated intestinal transplantation and rehabilitation program that provides patients with a world class evaluation, treatment and post-surgery care and support through its renowned, experienced and highly coordinated team of medical and surgical specialists, nurses and coordinators. As and when needed, doctors from other specialties are looped in as well for their expert guidance and preventive care suggestions.

Very few organ transplant programs in India offer comprehensive medical care and facilities for pre and post-transplant management and hardly any meet the standard that the Fortis team has painstakingly set for themselves. In this age where hospitals have commercialized the transplant industry, the Fortis team closely works with patients and their families to determine if a transplant is the most appropriate route to be taken, the procedure to get onto the waiting list, the entire pre/during/post surgery care and so on. They leave no stone unturned in keeping all up to speed by doing the right diagnosis, having detailed discussions with the patients and their families to explain the procedure in detail and then performing transplants with international standards of accuracy and success rate.