A bowel transplant is a surgery to replace a section of bowel in a patient with intestinal failure, a form of organ failure where the intestines are no longer able to absorb nutrients. A surgical specialist performs this procedure and monitors the patient during recovery to make sure the transplant was successful and help the patient adjust. Bowel transplants usually involve donor tissue from someone who has died, but some facilities may consider transplants using living donors, if they feel this is appropriate for a patient's needs.
Patients may enter intestinal failure for a number of reasons. In very young children, it is often the result of a congenital abnormality in the structure of the bowel. Adults may develop this condition as the result of chronic bowel inflammation, like Crohn's disease. When the bowels start to fail, the patient will transition to total parenteral nutrition (TPN). Eventually, patients meeting their nutritional needs this way can develop complications, and a bowel transplant may be recommended.
A patient with a referral for a bowel transplant will meet for a consultation to talk about the procedure and learn what to expect during and following surgery. The surgeon will order a series of tests to see if the patient is a good candidate for surgery, and will also perform a patient interview. In the interview, the surgeon will collect important information about the patient's medical history to identify any potential causes for concern. Once the surgeon clears the patient for surgery, the process of finding a matching donor can begin. When a match is found, the surgery will take place as soon as possible.
In the bowel transplant procedure, the patient is placed under general anesthesia and the surgeon removes the section of diseased bowel, replacing it with the donor bowel. The patient will continue to receive TPN while the surgical site heals, and will start to transition to liquid and eventually solid foods over the course of weeks. It usually takes six weeks or more to stop relying on TPN for nutrition and patients may experience setbacks, extending this time period.
Potential risks of a bowel transplant include rejection, where the body attacks the transplanted tissue, causing inflammation and tissue death. Patients can also develop infections at the surgical site, or may experience problems with the transition process from TPN. Working with an experienced surgeon will increase the chances of a positive outcome. Patients may also find it helpful to meet with a nutritionist to talk about recovery and their dietary needs.