The Nebraska Medical Center performs several types of transplant surgeries involving the small bowel alone or with other organs. These include:

• small bowel alone
• small bowel and liver
• multi-organ transplant (small bowel, liver, pancreas and stomach)

Transplant candidates will undergo an evaluation process that includes various tests, radiology and consults with our transplant team. The team will be available to answer your questions about the transplant process and will help you make an informed decision about whether a transplant is right for you.

About Small Bowel and Small Bowel/Liver Transplants

Isolated small bowel transplants and combined small bowel/liver transplants are still considered investigational treatments for adult and pediatric patients with short bowel syndrome and short bowel syndrome complicated by concomitant liver failure, usually secondary to chronic total parenteral nutrition (TPN), respectively. This is due to the complexity of the surgery and the fact that so few centers in the country perform these types of transplants. The Nebraska Medical Center became one of the first hospitals in the country to perform this sophisticated surgery in 1993. We are one of eight transplant centers in the country that is Medicare-approved to perform small bowel transplants.

The following factors help determine whether a patient should be considered for these procedures:
• the morbidity and mortality of untreated patients in similar clinical condition over the period in which the procedure has been performed;

• how often the procedure has been performed, where it has been performed, and the success or failure of the procedure as measured by the morbidity and mortality of patients undergoing the procedure;
  
• the reputation of the medical center and doctors who are performing the new procedure and their record in related areas;
  
• the long term prognosis of the patients who have had the procedure performed on them and lessons that can be derived from related procedures;
  
• If the benefits are judged to outweigh the risks, then approval for transplantation may be granted by the small bowel transplant team.

Indications/Contraindications for Transplantation

In patients where liver function is felt to be irreparably damaged, combined small bowel/liver transplant may be indicated. The increased complexity of the combined small bowel/liver transplant procedure makes it a less acceptable risk option for patients. Contraindications to isolated small bowel and combined small bowel/liver transplantation are listed below.

Specific Indications:

Short Bowel Syndrome

1. Microvillus atrophy
2. Extensive atresia
3. Volvulus neonatorum
4. Necrotizing enterocolitis
5. Crohn's disease
6. Mesenteric vascular occlusion
7. Trauma
8. Other nonmalignant causes of short bowel syndrome

Liver failure

1. Total parenteral nutrition
2. Other Consortium-approved indications for liver transplantation

Contraindications:

1. Alcoholism (not known to be abstinent for at least six months, if appropriate) subject to psychiatric and medical consideration
2. Active infection outside the hepatobiliary system
3. Active ulcer disease
4. Unstable current psychotic disease (pre-liver failure)
5. Uncontrolled malignancy
6. Severe cardiac, pulmonary, vascular, renal, or CNS disease that would make the risk of transplantation prohibitive
7. Other life-limiting illnesses