• Intestinal Transplant

    Patients with irreversible intestinal failure -- along with complications related with parenteral nutrition (PN) -- may need to consider a small bowel transplant. Intestinal transplantation has moved from experimental medicine to an important therapy option for a select group of patients. Even though dog intestinal transplants have been performed since 1959 and human transplants have been performed since 1967, real success did not take place until after 1990. Until the 1980s, no patient receiving a small bowel transplant lived for more than 79 days. Patients died of either surgical problems or rejection (because anti-rejection medicines were not powerful enough). Nationwide, one-year survival rates now stand at approximately 80 percent and five-year survival rates are at about 65 percent.

    The intestinal transplantation team at Cincinnati Children’s is led by pediatric gastroenterologist Samuel Kocoshis, MD, and pediatric surgeon, Jaimie Nathan, MD. Together, they have performed more than 300 liver transplants at Cincinnati Children’s since 1986 and more than 30 small intestinal or small intestinal-liver combined transplants.

    Conditions Treated

    Intestinal transplants are sometimes needed due to:

    • Chronic intestinal pseudo-obstruction
    • Congenital enteropathies, including tufting enteropathy and microvillus inclusion disease
    • Crohn’s disease following extensive small bowel resection
    • Desmoid tumors of the abdomen necessitating extensive small bowel resection
    • Gastroschisis
    • Hirschsprung’s disease
    • Intestinal atresia and stenosis
    • Intestinal malrotation and volvulus
    • Necrotizing enterocolitis
    • Surgical short bowel syndrome
    • Trauma
  • Types of Intestinal Transplantation

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    Our team is very skillful in preserving central venous catheters and maintaining adequate access to IV nutrition. In addition, we are very skilled at preventing life-threatening complications of blood stream infections. However some children come to us after having lost many central venous catheters and they are at risk for losing all of their access for intravenous nutrition. Others have suffered more than one infection that has threatened their lives and caused many of their organs to "shut down" Those patients need to come off TPN as soon as possible and isolated small bowel transplantation can facilitate getting them off intravenous nutrition. Yet another group of patients is born with bowel disorders that result in massive loss of salt and fluid. These children may lose their lives if their intravenous fluids are interrupted for more than a few hours. They are at such risk that they need small intestinal transplantation as well. When an isolated intestinal transplant is considered, the native stomach, small bowel, and liver are maintained and the only organ transplanted is the small intestine.
    In past years, one of the most devastating complications of IV nutrition was liver failure. However, because our team initiated important treatment innovations over the past 10 years, the risk for liver failure has declined considerably. Unfortunately, a few patients receiving intravenous nutrition will develop liver failure despite our best efforts. When liver failure complicates intestinal failure, we transplant the liver along with the intestine. The donated pancreas is also transplanted because it is more dangerous to attempt to remove it than to keep it in place.

    Because some patients have disorders of the nerves or muscles of the gastrointestinal tract, the movement of food down the gastrointestinal tract may be so disorganized that they develop intestinal failure needing intravenous nutrition. In those situations, complications such as liver failure, loss if central venous access and life-threatening blood stream infections may occur. When they do occur, some transplant programs remove the patient's stomach, duodenum, the rest of the small and large intestine, and possibly the liver, replacing all of them with new organs. This procedure is called a multi-visceral transplant or a modified multi-visceral transplant. Our team prefers to leave intact a small amount of native stomach and to sew it directly to the transplanted small intestine. The excellent results we have enjoyed leaving in part of the native stomach prompt us to avoid multi-visceral transplantation if possible.

  • What is Involved in an Intestinal Transplant?

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    Patients will come to Cincinnati Children's Hospital Medical Center for a week-long admission to undergo testing to determine if they are a candidate for small bowel transplantation.

    The transplant team works with the local and national transplant lists to find an appropriate organ(s). Organ allocation is based on medical urgency, time on the waiting list and blood type compatibility.

    The transplant surgeon removes the donor organ, removes the recipient's damaged small bowel and then attaches the new donor small bowel.

    Most small bowel transplant recipients spend several weeks in the hospital. This is longer than for other types of organ transplant. The team will monitor the recipient for rejection, infection and other complications.