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TRANSPLANT SERVICES

Intestinal and Ex Vivo Transplant

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At NewYork-Presbyterian, we have a highly experienced team of surgeons, gastroenterologists, nurse practitioners, social workers, psychiatrists, and nutritionists who will provide care and guidance through every step of your transplant surgery and recovery. Across our two campuses, we have performed the most transplant surgeries in the United States and remain one of the few organ transplantation centers to offer both intestinal transplant and ex vivo procedures.

What is an Intestinal Transplant?

What is an Intestinal Transplant?

An intestinal transplant, also known as a small bowel transplant, is an operation that replaces an unhealthy or shortened small bowel with a healthy bowel from a donor. After removing the diseased bowel, the new bowel is then connected to the rest of the digestive tract.

You may need an intestinal transplant if your intestines stop absorbing nutrients and fluids.  This condition is called intestinal failure. Intestinal failure occurs when someone’s intestines stop absorbing nutrients and fluids from food. Patients with intestinal failure require parenteral nutrition (PN) support, typically through a drip into a vein. PN refers to a method of receiving nutrients by bypassing the digestive system.

An intestinal transplant can become necessary for intestinal function when a patient has complications related to the PN. Intestinal transplants also treat patients with short bowel syndrome (also known as short gut syndrome), intestinal trauma, or selective unrespectable intestinal tumor.

What is an ex vivo surgery?

Ex vivo surgery is a medical procedure in which organs are taken out of a living body to facilitate tumor resection and then returned to the body. At NewYork-Presbyterian, ex vivo surgery is used to remove deeply embedded abdominal tumors that are unreachable and untreatable by conventional techniques.

How is an Intestinal Transplant Performed?

Procedures

An intestinal transplant, or small bowel transplant, aims to replace a diseased small intestine with a healthy one. The surgery can take about 8 - 10 hours to complete.

The steps that are taken during an intestinal transplant procedure are:

  • Finding and confirming a donor organ that is a match prior to surgery
  • Putting the patient under anesthesia (so they sleep through the surgery)
  • Removing the diseased bowel
  • Connecting the patient’s blood vessels to the blood vessels of the new bowel
  • Connecting the new bowel to the patient’s digestive tract or what is left of the bowel
  • Performing an ileostomy, where a part of the small bowel is put through an opening in the abdomen, called a stoma
  • Taking the patient to the intensive care unit (ICU) immediately after surgery to be monitored

How is an ex vivo surgery performed?

Patients with tumors that can’t be treated through other surgeries or techniques may be eligible for ex vivo surgery. The goal is to remove multiple organs from the patient’s body to reach, treat, and remove otherwise untreatable tumors. The procedure can take about 12 to 24 hours to complete.

The steps that are taken during an ex vivo surgery are:

  • Putting the patient under anesthesia (so they sleep through the surgery)
  • Making a long incision (or deep cut) across the abdomen
  • Severing, or cutting, the connections between the diseased organs and the body
  • Removing the affected organs from the body
  • Removing tumors and cancerous tissue from the affected organs
  • Placing the vital organs back inside the patient
  • Closing the incision and moving the patient into the ICU for monitoring

More to explore

Types of Intestinal Transplants

Types

There are several types of transplant surgeries available for patients with intestinal failure or other organ failures. In some cases, organs around the bowel are also damaged or failing, requiring the doctor to perform a more complicated transplant procedure.

The types of intestinal transplants available are:

  • Isolated intestinal transplant. This surgery is for patients with complications caused by intestinal failure, but who do not have liver failure. During the procedure, only the diseased portion of the bowel is removed and replaced with a donor bowel.
  • Multivisceral transplant. This procedure is for patients who have multiple organ failure, including stomach, pancreas, liver, small intestine, or kidney failure. This transplant involves removing all diseased organs and replacing them with healthy organs.
  • Modified multivisceral transplant. This procedure is an option for patients who do not have liver disease or failure but have organ failure of the stomach, pancreas, small intestine, or kidneys. All the diseased organs except the liver are removed and replaced with healthy organs.
  • Liver intestinal transplant: This procedure is performed in patient with intestinal and liver failure.

Who is Eligible for Intestinal Transplantation?

Eligibility

Intestinal transplantation is offered to people with life-threatening complications such as loss of venous site to insert a catheter to administer PN, bacterial and fungal infections associated with a catheter, or liver failure associated with PN toxicity can occur.

You or your child may indicate intestinal transplantation if you have:

  • Short gut syndrome (the most common reason for intestinal transplantation in children)
  • Intestinal dysmotility (problems moving food through the intestine)
  • Inflammatory bowel disease (Crohn’s disease and ulcerative colitis)
  • Intestinal trauma
  • Volvulus (twisting of the intestine that causes obstruction)
  • Recurrent obstruction of the intestine
  • Necrotizing enterocolitis (inflammation and death of intestinal tissue, most often in premature infants)
  • Gastroschisis (intestines growing outside a baby’s body, through the wall of the abdomen)
  • Certain tumors (such as Gardner’s syndrome with desmoids tumors)
  • Mesenteric vascular thrombosis (blood clots in blood vessels supplying the intestine)
  • Radiation enteritis (inflammation of the intestine due to radiation therapy)
  • Developed liver failure due to PN

Patients need to undergo an extensive evaluation to determine that other organs in the body are working well and will be healthy enough to support you during this difficult procedure.

Risks to Consider

Risks

There are some risks associated with having an intestinal or ex vivo transplant, so it is important to talk with your doctor about which procedure is right for you. Depending on someone’s medical history, and the type of transplant they undergo, they could be more or less at risk for complications after surgery.

Risks associated with intestinal transplants

  1. Posttransplant lymphoproliferative disease
  2. Bile leaks
  3. Heart and breathing problems
  4. Blood clots
  5. Depression or anxiety
  6. Donated organ failure or rejection
  7. Increased risk of skin and certain other cancers
  8. Bacterial and fungal infections
  9. Viral infections
  10. Internal bleeding
  11. Vascular complications

Risks associated with ex vivo surgery

  1. Postoperative hemorrhage
  2. Vascular leaks or obstruction
  3. Bile leaks
  4. Depression or anxiety
  5. Donated organ failure or rejection
  6. Increased risk of skin and certain other cancers
  7. Infection
  8. Internal bleeding
  9. Intestinal leaks

Preparing for an Intestinal Transplant

Preparing for an Intestinal Transplant

Your doctor will have specific instructions to help you prepare physically and emotionally for your intestinal transplant. When a donor organ becomes available, you will receive a phone call telling you to go to the hospital to prepare for your surgery.

Some of the steps you could take to prepare for your small bowel transplant are:

  • Stop drinking alcoholic drinks or smoking
  • Follow dietary recommendations given by your doctor in the weeks leading up to the surgery
  • Pack all of your medicines in a go-bag, along with a list of your dosages and when you take them
  • Have a list of your family or care team’s phone numbers available
  • Have your driver’s license or picture ID and insurance card accessible
  • Refrain from eating for at least 6 hours before surgery
  • Refrain from drinking any liquids for at least 2 hours before surgery

What to Expect After an Intestinal or Ex Vivo Transplant

After the Surgery

After an intestinal or ex vivo transplant, you will remain in the hospital so the doctors can monitor your progress and healing after surgery. Depending on your procedure, you may be recovering or in the hospital for a longer period of time. Patients who have either surgery will likely have to take medication for the rest of their lives. Your doctor and care team will talk to you about the best treatment and recovery plan for you.

What to expect after an intestinal transplant

  • Patients typically remain hospitalized for 4 - 6 weeks after surgery
  • You will have tubes in your veins to provide medicine and fluids
  • You’ll be attached to monitoring equipment so doctors can oversee your recovery
  • You might have a feeding tube in place until you can eat a regular diet
  • You may have regular biopsies to monitor the health of your new bowel
  • You may have regular endoscopies to examine your bowel and intestines
  • You’ll be given anti-rejection (also called immunosuppressants) and anti-infective medicines to ensure your body doesn’t reject your new organ
  • For the first months after leaving the hospital, you’ll need to have regular blood tests and endoscopies to monitor your transplant
  • By six months, you may only need to take one or two of the original medications prescribed
  • In most cases, immunosuppressants will have to be taken for the rest of your life 

What to expect after an ex vivo surgery with auto transplant

  • Patients are typically hospitalized for one month or more
  • You may have a feeding tube or ventilator for a period of time after surgery
  • If you received a donor organ, your recovery will look similar to the recovery from an intestinal transplant (lifelong immunosuppressant medication, regular biopsies, endoscopies and bloodwork to monitor progress, along with anti-rejection and anti-infective medications)
  • Full recovery can take several months or over a year

FAQs

FAQs

About 50 - 70% of patients successfully accept a small intestine after transplant surgery.

The is a 70% survival rate for patients who have had a multivisceral transplant after 1 year. There is a 50% survival rate after five years.

 

This content has been reviewed by the following medical editors.

Mercedes Martinez, MD

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Choose NewYork-Presbyterian for your Intestinal Transplant or Ex Vivo Procedure

The intestinal failure team at NewYork-Presbyterian includes highly experienced and caring specialists that will be there for you through every step of the transplant process. Our organ transplant team has been performing small bowel transplantation for more than two decades and has achieved 100% patient graft survival one year after surgery in pediatric patients.

The strength of the transplant program at NewYork-Presbyterian and our expertise make our institution an internationally renowned hospital for the treatment of these complex procedures. Throughout the transplant process and beyond, we help you and your family navigate any emotional, financial, and logistical concerns you may have.

Call to schedule an appointment today to learn more about our services and discuss which treatment option is right for you.