Intestinal and Multivisceral Transplant

What is an intestinal transplant?

An intestinal transplant is a life-enhancing operation that replaces a failing intestine with an intestine from a deceased donor. If a child’s intestine can no longer digest food and absorb fluids — essential to normal development — an intestinal transplant may be an option.

Small intestines can be transplanted by themselves or with other abdominal organs, depending upon the needs of the child.

Isolated small intestine transplant

Transplanting only the small intestine is the best option when a child with permanent intestinal failure does not have disease in other abdominal organs, such as the liver, stomach, or pancreas.

Liver-intestine transplant

A liver-intestine transplant means that the liver is transplanted in addition to small intestine. This is the best choice when a child has permanent intestinal failure and significant or irreversible liver damage, most often from intravenous nutrition.

Multivisceral transplant

A multivisceral transplant means that the liver, small intestine and other abdominal organs (for example, the stomach and pancreas) are transplanted at the same time.

Why is an intestinal or multivisceral transplant recommended?

Your child may need an intestinal or multivisceral transplant if the small intestine has permanently failed: when the intestine has little chance to ever be able to digest and absorb enough nutrients to support growth and daily functioning.

Most of the time, intravenous nutrition, also called total parenteral nutrition (TPN), can support growth and functioning, but giving nutrition this way oftentimes has complications, such as serious infections, blockages in important blood vessels and serious damage to the liver. Intestinal transplant or multivisceral transplant is offered as a therapy when:

  • there is permanent intestinal failure
  • TPN is causing serious complications
  • dehydration from chronic diarrhea or fluid losses is life-threatening or extreme

The most common cause of intestinal failure is short bowel syndrome (SBS). Causes of SBS include:

Other causes of intestinal failure in children and adults are:

  • pseudo-obstruction
  • aganglionosis/Hirschsprung disease
  • intractable infant diarrhea, such as microvillus inclusion disease
  • tumors
  • Crohn’s disease
  • hypercoaguable state
  • conditions causing blood vessel blockage to intestine

Evaluation for intestinal or multivisceral transplant

An evaluation is necessary to carefully review your child’s medical history and laboratory information, determine the risks and benefits of transplant for your child and identify potential problems. If your child is being evaluated for a transplant, they will see a number of health care professionals that might include:

  • transplant surgeon
  • transplant hepatologist (liver specialist)
  • anesthesiologist
  • intestinal/multivisceral transplant coordinator/nurse practitioner
  • social worker
  • pharmacist
  • dietitian
  • infectious disease specialist
  • financial coordinator
  • child life specialist

During the evaluation, your child will undergo a number of tests that may include:

  • blood tests to determine blood type (a donor and recipient must have compatible blood types); blood count, liver and kidney function; viruses your child may have been exposed to, such as hepatitis A, B and C, the AIDS virus, CMV, EBV and herpes simplex virus;; coagulation studies; and nutrition studies
  • abdominal ultrasound that allows physicians to see the liver and flow of blood through arteries and veins
  • liver biopsy to obtain a small sample of your child’s liver
  • endoscopy to examine your child’s digestive tract
  • upper GI series to evaluate the anatomy of the upper portion of the GI tract, check intestinal length, and rule out obstruction
  • computed tomography (CT) scan with angiography to evaluate blood vessels and abdominal organs
  • gastric emptying scan to evaluate how quickly the stomach empties
  • barium enema to evaluate the lower part of the GI tract (colon and rectum)
  • motility testing to evaluate how the intestine moves, contracts and relaxes
  • echocardiogram (cardiac ultrasound) to evaluate if the heart is structurally normal
  • chest x-ray to see if your child’s lungs are healthy
  • tuberculosis testing (PPD) if not completed by pediatrician