Results of intestinal transplantation have improved over the past decade. Early attempts at transplantation were hindered by technical and immunologic complications that led to graft failure or death. As a result of recent surgical advances, control of acute cellular rejection, and a decrease in lethal infections, the rate of patient survival at 1 year now exceeds 90%.
The role of intestinal transplantation in the treatment of patients with gut failure is indeed considerable.
Total Parenteral Nutrition (TPN=artificial nutrition) is currently the primary maintenance therapy for a patient in whom their intestinal absorptive function has failed.
However, in India, due to paucity of intestinal failure services, financial constraints for long-term TPN, poor hygienic practices and the lack of awareness for the need of sterile techniques to handle TPN catheters, intestinal transplantation may be the right choice for such patients rather than bridging with TPN.
Transplantation is offered to patients with irreversible gut failure who have one of three problems:
- Complications of TPN
- Inability to adapt to the quality-of-life limitations posed by intestinal failure
- High risk of death if the native gut is not removed (as in the case of un-resectable mesenteric tumors or chronic intestinal obstruction)
Surgical procedures involved are grouped under the amount of the intestine that is transplanted.
- Intestine alone transplant (IT) for transplanting only the small intestine
- Modified multivisceral transplant: where all of the abdominal gastro-intestinal organs except the liver is transplanted
- Multi-visceral transplant: Where are the abdominal gastro-intestinal organs including the liver is transplanted.
The conditions that lead to the requirement of an intestinal transplant are varied and range from loss of intestine due to compromised blood supply to inflammation (Crohn’s and Ulcerative colitis) and cases of slow growing tumours of the abdominal cavity such as neuro-endocrine tumours and desmoid tumours.