Intestinal transplantation is a surgical treatment for intestinal failure. It is one of the most rarely performed transplant procedures performed, exclusively involving the transplantation of donor small bowel to a recipient, with an ileostomy formation.
Due to the high risk of complications with the procedure, it is usually reserved for patients with intestinal failure who are unable to be sustained on total parental nutrition (TPN) due to complications of TPN treatment 1,2.
With continued improvements in donor selection, organ preservation and operative techniques recent studies report improvements in outcomes from intestinal transplants to be comparable with that from lung transplantation 7.
There are essentially two main patient groups that are candidates for small bowel transplantation:
short bowel syndrome
- commonly due to previous surgical bowel resection
- functional disorders
- impaired motility
- impaired absorption despite sufficient gut length
- untreated systemic or local infections
- severe cardiac or pulmonary failure
- malignancy (relative contraindication) 2
Both live donor and cadaveric operations are performed depending on whether intestinal transplant is being performed in isolation or combination with other visceral transplants.
Live donor intestinal transplants
- between 150-200 cm of ileum including 20-25 cm of ileocaecal valve/terminal ileum harvested from a donor
- end-to-side anastomosis of donor ileocolic artery and vein to recipient aorta and inferior vena cava (IVC) respectively
- proximal anastomosis of donor ileum and recipient bowel or stomach
- Bishop-Koop ileostomy formation
Cadaveric intestinal transplants
- the intestinal graft can either have venous drainage via the IVC or via portal system (superior mesenteric vein)
- arterial anastomosis to abdominal aorta, usually infra-renal
- intestinal anastomosis as for live donor
Combined intestinal-liver transplants
- concomitant liver failure related to TPN
- hypercoagulable states causing intestinal failure that are correctable with liver transplantation
- arterial anastomosis between a patch of donor aorta including the coeliac axis and SMA origin to recipient aorta
- donor-recipient porto-portal venous anastomosis
- cavo-caval venous anastomosis
- Roux-Y-choledocho-enterostomy for biliary drainage
- used in patients with invasive abdominal malignancies requiring multi-organ curative surgical resection
- 1. Nayyar Navdeep, George Mazariegos and Sarangarajan Ranganathan et al. "Pediatric small bowel transplantation". Seminars in Pediatric Surgery 19, no. 1 (2010): 68-77. . doi:10.1053/j.sempedsurg.2009.11.009.
- 2. Holzheimer R and John A Mannick. Surgical treatment. 1st ed. München: Zuckschwerdt, 2001.
- 3. Middleton S J. "The current status of small bowel transplantation in the UK and internationally". Gut 54, no. 11 (2005): 1650-1657. . doi:10.1136/gut.2004.062612.
- 4. Bhargava Puneet, Nadir Khan and GraceS Phillips et al. "Imaging in pediatric small bowel transplantation". Indian Journal of Radiology and Imaging 24, no. 4 (2014): 379. . doi:10.4103/0971-3026.143900.
- 5. Godfrey E.M., S.S. Upponi and T.C. See et al. "A radiologist's guide to small bowel and multivisceral transplantation". Clinical Radiology 68, no. 10 (2013): 983-991. . doi:10.1016/j.crad.2013.03.010.
- 6. Phillips Grace S., Puneet Bhargava and Luana Stanescu et al. "Pediatric intestinal transplantation: normal radiographic appearance and complications". Pediatric Radiology 41, no. 8 (2011): 1028-1039. . doi:10.1007/s00247-011-2094-3.
- 7. Grant D. Intestinal transplantation: 1997 report of the international registry. Intestinal Transplant Registry. Transplantation. 67 (7): 1061-4. Pubmed