Transplant Center

Performing an isolated intestinal transplant generally takes less time than a combined liver/intestinal/pancreas transplant. Depending on the organ(s) transplanted the operation will take between four to seven hours to complete. The surgical incision is made in either a horizontal or vertical direction. The next few hours are spent removing the old organ(s). The blood vessels are then attached, an ileostomy is created and the skin is closed. An ostomy is an opening from inside the abdomen to the outside of the abdomen and is used for elimination of stool as well as monitoring the new intestine for rejection. Depending on the type of intestinal failure some ostomies are temporary and others are not. If the ostomy is temporary and the patient remains stable, the bowel can be reconnected within three to six months after the initial transplant.

After the operation

After surgery, patients are taken directly to the intensive care unit (ICU). The time spent in the ICU varies on the individual patient's condition. An average hospital stay is between one and two months and may be longer. Once a patient leaves the ICU they move to the solid organ transplant unit (SOTU) or the pediatric unit. Once on these units activity and diet are advanced as quickly as possible. Most patients require Total Parenteral Nutrition (TPN) for a short period of time as they advance to oral feedings. Adult patients will start on a clear liquid diet a few days after transplant and will advance to a no-added-salt diet as soon as they can tolerate solid foods. Most children require a time of enteral (naso-gastric/feeding tube) feedings to support their wound healing and growth and development. Activity will also be advanced as tolerated. Patients are encouraged to be out of bed and active as much as possible. Physical and occupational therapy will be started as early as possible to help with activity.

Potential Complications

At The Nebraska Medical Center we have some of the most experienced physicians and nurses who take every step to prevent any of the potential complications that can occur following transplantation of the intestine or intestine/liver/pancreas. However, like any major surgery, complications can happen and include both surgical and medical complications.

Surgical Complications can include but are not limited to the following;

• Wound infections
• Perforation of the intestine (hole in the intestine)
• Abdominal abscess (pocket of infection)
• Anastomotic leaks (Leaking from the blood vessel connections)
• Biliary leaks (leaking from the bile ducts)

The most common medical complications after intestine or liver/intestine/pancreas transplant are;

• Hypertension (high blood pressure)
• Rejection of the new intestine or liver
• Infection
• Kidney dysfunction
• Diabetes

The severity of these complications in each patient varies and cannot be predicted prior to the transplant.

High Blood Pressure of Hypertension
There are many causes for high blood pressure after transplantation. Hypertension generally occurs right after surgery but goes away in time. Patients usually leave the hospital on blood pressure medication, but over time these drugs are usually eliminated. The only long-term medications patients will be required to take are anti-rejection. These medications are used to prevent the body from rejecting the transplanted organ(s). New medications are being tested, so the drug therapy after transplantation may change. Right now, anti-rejection medication therapy is considered lifetime medication.

Rejection of New Intestine or Liver
Most patients have some degree of transplant rejection. This can occur in either the intestine or the liver. Rejection is not something that you usually see or feel; it is something that the physician diagnoses by looking at ostomy outputs or liver function tests. The only way to confirm rejection is through an intestinal or liver biopsy. Routine intestinal biopsies are performed through the ostomy while patients are in the hospital.  Liver biopsies are only performed when the liver function tests are consistently elevated.

Treatment of Rejection
Rejection is usually treated with medication. There are several different medications that may be used to reverse rejection. If these medications fail, patients may require retransplantation.  A patient with an isolated intestine transplant who has aggressive and untreatable rejection, the transplanted bowel may have to be removed. If this happens the patient is placed back on TPN, recovers from the operation and can eventually be placed back on the transplant list.  Other less common reasons for the removal of a transplanted bowel include clots to the blood flow of the intestine, severe infection or lymphoma. In combined transplants rejection of the liver is usually treatable with medication (see liver section).

Infection
Infection may occur in any body system and most of the infections are caused by organisms common in the environment or in and on the patient's own body. These organisms include bacteria, fungi (molds and yeasts) and viruses. Other people (nurses, doctors, or family members and friends) who come into regular contact with you don't risk transmission of serious infections. Although you may get colds and flu, these are not the kinds of infections that are associated with serious threat to life; therefore you are not placed in isolation.