Intestine Transplant in India
Intestinal transplantation plays a significant part in the care of patients with intestinal failure. However, it is one of the rarest and most complex procedures with a high risk of infection and rejection of the transplanted intestine. However, by combining the skill of an expert surgeon and advanced technologies, this procedure can enable the patients to return to their normal lives.
The early attempts of intestine transplant in India were hampered by immunologic and technical issues that resulted in graft failure or death. Fortunately, the outcomes have improved enormously over the last decades. Recent surgical advancements, management of acute cellular cell rejection, and a decline in fatal infections greatly increase the rate of survival rate.
What Is Intestinal Failure and What Causes It?
Intestinal failure can be described as the inability of the intestine to digest and absorb nutrients necessary for the proper functioning of an individual. The condition is characterized by a reduction of the function of the small intestine below a specific threshold. The majority of intestine failure is caused by short gut syndrome, a condition caused by surgical resection that results in the loss of the small intestine’s functioning mass.
Intestine Transplant Is Conducted For Whom?
The intestine transplant is an important procedure that can be life-saving for patients with a dysfunctional intestine. Patients with irreversible gut failure who suffer from one of three issues are eligible for transplantation.
- Patients with intestinal failure.
- Patients having complications from total parenteral nutrition.
- Patients with intestine disorders that can be life-threatening if not removed.
The digestion and absorption of the majority of food, fluid, electrolyte, and nutrient digestion and absorption occurs in the intestine. Dysfunction of the intestine will lead to a health issue that results in malnourishment and dehydration. It will cause symptoms such as diarrhea, poor growth, frequent infections, exhaustion, muscle atrophy, etc.
Intestinal Diseases That Lead To Requirement of Intestine Transplant
Common intestinal diseases that can cause requirements of intestine transplant are:
Short gut syndrome such as:
- Advanced Crohn’s disease.
- Desmoid tumors.
- Necrotizing enterocolitis.
- Intestinal atresia and stenosis.
- Massive intestinal polyposis.
Defective gastrointestinal motility such as
- Hirschsprung’s disease.
- Extensive visceral neuropathy.
- Hollow visceral myopathy.
- Total intestinal aganglionosis.
- Chronic intestinal pseudo-obstruction.
Impaired enterocyte absorptive function such as:
- Tufting enteropathy.
- Microvillus Inclusion Disease (MID).
- Selective autoimmune enteropathy.
Types of Intestine Transplant
There are different surgical approaches for intestine transplant. The three main procedures of intestine transplant in India are:
- Small bowel transplant – Only the small intestine is transplanted in this procedure.
- Modified multi-visceral transplant – All the abdominal organs are transplanted except for the liver.
- Combined intestine and liver transplant – All the abdominal organs including the liver are transplanted.
Donation of An Intestinal Graft
The first requirement to perform an intestine transplant is an intestinal graft. An intestinal graft can be obtained from:-
- A brain-dead donor.
- A related living donor.
If the donor is brain dead, the entire small intestine can be used for transplantation; however, if the donor is living, about 40% of the small intestine (which normally measures between 600 and 800 cm) can be removed without posing a serious risk to the donor.
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Intestinal Transplant Procedure
The procedure of intestine transplant in India involves linking the patient’s and donor’s blood vessels to provide blood flow to the transplanted intestine. The gastrointestinal tract of the patient is gradually joined to the donor’s intestine. This process will be followed by ileostomy.
To perform an ileostomy, an incision is made on the abdominal wall through which the ileum, a portion of the small intestine, is brought out. This aperture permits routine biopsies to check for rejection. The goal is to start enteral feeding as soon as possible following the transplant. Over time, the majority of patients having intestine transplant in India have their ileostomies closed and their normal intestinal function restored.
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Best Intestine Transplant Hospitals in India
1. Medanta-The Medicity Hospital, Gurgaon
2. Artemis Hospital, Gurgaon
3. Fortis Memorial Research Institute, Gurgaon
4. Manipal Hospitals Dwarka, Delhi
5. Indraprastha Apollo Hospital, New Delhi
6. Apollo Hospitals, Greams Road, Chennai
7. Max Super Specialty Hospital, Saket
8. BLK Hospital New Delhi
9. Kokilaben Dhirubhai Ambani Hospital Mumbai
10. Global Hospital, Chennai
Complications Associated With Intestine Transplant
Several risks are associated with intestine transplant. Numerous bacteria and lymphoids are present in the intestine making the patient more prone to infection or transplant rejection. This makes it necessary to administer heavy doses of anti-rejection medications to the patients, suppressing their immune systems to prepare the body to accept the transplanted intestine which is in turn harmful to the patient’s health. Common complications are:
- Infection.
- Rejection of the transplant.
- Intestinal ischemia.
- Fluid leakage.
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Why Would You Choose To Have an Intestine Transplant in India?
Among organ transplants, intestine transplant is an uncommon procedure due to the high rate of rejection and infection. Only a few countries have successfully operated and India is one of them. The first successful intestine transplant in India was performed on November 24, 2012. Since then, India has significantly improved in the area, and to date, numerous successful intestine transplants have been carried out in India.
Additionally, India is a popular destination for medical tourism as the country is renowned for its advancement in the area of healthcare. Hospitals in India are well-equipped with the most advanced facilities, ensuring the best possible outcome for the patients. Also, the cost of intestine transplant in India is much more affordable as compared to other countries. The cost-effectiveness makes it more attractive for patients seeking high-quality treatment at an affordable price.
FAQ’s
Q: How Can A Person Survive After the Removal Of the Intestine?
A: A healthy intestine is still able to perform adequately even if 40% of its length is removed. This enables a living person to donate their intestine. If the intestine fails and the patient cannot eat or digest food normally, intravenous parenteral nutrition is used to feed the patient. This involves injecting fluids straight into an intravenous catheter inserted into one of the body’s large veins. The patient is given nutrients like glucose, amino acids, lipids, vitamins, and minerals based on their specific needs, which can vary.
Q: What is The Intestinal Transplant Success Rate?
A: According to the International Registry for Intestinal Transplantation, since 1995, there has been an improvement in both graft and patient survival rates, with 69% of patients surviving for one year and 55% of grafts surviving.
Q: Why Are Intestinal Transplants So Challenging?
A: The intestine has a lot of tissue that can be rejected, which can lead to the loss of the intestine’s surface lining and expose the patient to bacterial infections through stool. This is one of the reasons for the difficulties.
Q: Is It Possible To Survive Without The Intestine?
A: It is more difficult to survive without a small intestine than without a stomach or large intestine for most people. When the small intestine must be removed entirely or mostly or ceases to function, liquid nutrients must be injected intravenously (IV) into the bloodstream.
Q: How Long Does It Take To Recover From Intestinal Surgery?
A: Following the transplant surgery, you will feel nausea and fatigue. You will start getting normal within two weeks after the surgery. Your bowel movements will not be consistent for several weeks. Generally, patients get back to normal condition within two to four weeks.
References
https://www.agappe.com/in/blog-details/case-study.html