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Gastrointestinal Disorders 2023

Intestinal transplantation: when to do it and how é recoveryç&athilde;o

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Intestinal transplantation: when to do it and how é recoveryç&athilde;o
Intestinal transplantation: when to do it and how é recoveryç&athilde;o

A bowel transplant is a type of surgery in which a doctor replaces a person's diseased small intestine with he althy intestine from a donor. Generally, this type of transplant is necessary when there is a serious problem in the intestine, which prevents the correct absorption of nutrients or when the intestine no longer has any type of movement, putting the person's life at risk.

This transplant is more common in children, due to congenital malformations, but it can also be done in adults due to cases of Crohn's disease or cancer, for example, being only contraindicated after 60 years, due to the high risk of surgery.

When it is needed

Intestinal transplantation is performed when there is a problem that is preventing the correct functioning of the small intestine and, therefore, nutrients are not being well absorbed.

Generally, in these cases, it is possible for the person to be fed through parenteral nutrition, which consists of providing the nutrients necessary for life through the vein. However, this may not be a solution for everyone, as complications such as:

  • Liver failure caused by parenteral nutrition;
  • Recurrent infections of the catheter used for parenteral nutrition;
  • Injuries to the veins used to insert the catheter.

In these cases, the only way to maintain adequate nutrition is to transplant a he althy small intestine so that it can replace the function of the diseased one.

How it's done

Intestinal transplantation is a very complex surgery that can take between 8 to 10 hours and needs to be performed in a hospital under general anesthesia. During surgery, the doctor removes the affected intestine and then puts the he althy intestine in place.

Finally, the blood vessels are connected to the new intestine, and then the intestine is connected to the stomach. To finish the surgery, the part of the small intestine that should be connected to the large intestine is connected directly to the skin of the belly to create an ileostomy, through which the stool will exit into a bag stuck to the skin, so that it is easier for physicians assess the evolution of the transplant, noting the characteristics of the stool.

What is the transplant recovery like

Recovery after bowel transplantation is usually initiated in the ICU to allow a constant assessment of how the new bowel is healing and whether there is a risk of rejection.During this period, the medical team often performs various tests, such as blood tests and endoscopies, to ensure that healing is taking place properly.

If there is rejection of the new organ, the doctor may prescribe a higher dose of immunosuppressants, which are drugs that reduce the activity of the immune system to prevent the organ from being destroyed. However, if it is healing normally, the doctor will ask for transfer to a normal ward, where analgesics and immunosuppressive drugs will continue to be administered into the vein until healing is almost complete.

Normally, after about 6 weeks after the surgery, you can go home, but for a few weeks you will need to go to the hospital frequently for tests and to continue to evaluate the functioning of the new bowel. At home, it will be necessary to keep taking immunosuppressive drugs for the rest of your life.

Possible causes

Some causes that can cause the bowel to malfunction and, consequently, lead to a bowel transplant include:

  • Short bowel syndrome;
  • Intestinal cancer;
  • Crohn's Disease;
  • Gardner's Syndrome;
  • Serious congenital malformations;
  • Ischemia of the intestine.

However, not all people with these causes can undergo the surgery and, therefore, it is necessary to carry out an evaluation before the surgery in which the doctor asks for several tests such as X-ray, tomography or blood tests. Some of the contraindications include cancer that has spread to other parts of the body, other serious he alth conditions, and age over 60, for example.

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