Know All About Small Intestine Transplant

Small Intestine and Its Main Function

It is a 20-feet folded tube that fits inside the abdomen and connects the stomach and large intestine. Ironically, it is the longest tube in the alimentary canal. It helps in the digestion of food coming down from the stomach and has three large parts: the duodenum, jejunum, and ileum. Small Intestine Transplant in India is successfully done in India at the lowest waiting time.

• The main function of the small intestine is to break down and digest food along with the absorption of nutrients including electrolytes, vitamins, and minerals from the food.
• It is the most absorbing organ in the gastrointestinal tract.

Nearly 90% of nutrient absorption takes place in the small intestine itself.

What is Small Intestinal Transplantation?

It is a complex surgical procedure to replace a damaged or shortened small bowel with a healthy one from a donor. 

What Causes Intestinal Failure?

• Short bowel syndrome is one of the main causes responsible for small intestinal transplantation. Short bowel syndrome occurs when a large part of the intestine is missing or damaged. Twisting of the bowel, baby’s bowels outside the body since birth, Crohn’s disease, and bowel cancer are its main causes. 
• Other conditions such as Crohn’s disease, digestive disorders, chronic idiopathic intestinal pseudo-obstruction syndrome, small bowel tumors such as Gardner’s syndrome are the main reasons for intestinal failures.
• Congenital malformations, for instance, small bowel atresia, GI tract-related infections, gastroschisis in infants or toddlers cause intestinal failure.

Conditions That Require Small Intestinal Transplant

• Doctors prefer small intestine transplants when an individual’s bowel system stops functioning properly or complications arise from total parenteral nutrition (TPN). TPN is a method of giving fluids through a drip into a vein that bypasses the gastrointestinal tract.
• Many people opt TPN method, but its long-term use can arise other serious health problems such as liver disease, bone disorders, central venous catheter infections, or recurrent infections.
• Doctors consider small intestinal transplantation when an individual faces a serious problem with their bowel or is unable to tolerate feeding from TPN. 
• In some cases, people are born with or develop irreversibly intestinal failure which leads to losing the ability to digest food and absorb nutrients. Patients are then given TPN to provide nutrition in the form of liquid through a catheter or drip inserted into the vein in the arm, groin, neck, or chest.

Types of Intestinal Transplants

There are three major types of intestinal transplants:

• Isolated Small Bowel Transplant: In this procedure, the surgeon removes a damaged portion of the small intestine and replaces it with a healthy one from a donor. This procedure is preferable when a person does not have liver disease.

• Combined Liver and Intestinal Transplant: This procedure is recommendable when a person has both – liver and intestine failures. In this process, the surgeon removes both organs and replaces them with healthy ones from a donor. Long-term use of TPN is the main cause of liver failure which is used in case of intestinal failure. 

• Multivisceral Transplant: Surgeons prefer this transplant when two or more intra-abdominal organs fail. The required transplanted organs may include the stomach, pancreas, duodenum, intestine, and liver. This is a cure to various diseases such as Gardner’s syndrome, intestinal pseudo-obstruction that drops down the ability of the intestines to push food through, and a pre-malignant colorectal condition. 

Intestinal Transplant Evaluation and Waiting List!

If you require a small bowel transplant, your doctor may conduct evaluation tests and diagnostic procedures within one to three weeks to check the right time to proceed with the transplant.

Depending on your overall condition, your doctor may admit you to the hospital to conduct tests or perform tests on outpatient appointments. These tests may include:

• Blood tests to check the functioning of the liver, kidneys, electrolytes, or if you may have any severe health condition, for instance, HIV or hepatitis.
• A colonoscopy in which your doctor inserts a long, thin tube with a camera at the other end into the mouth down to the intestine to check inside the bowels.
• A series of imaging tests of your whole abdomen including an ultrasound of the liver. 
• And pulmonary function tests. 

Assessment Process

During the assessment process, you will get a chance to ask questions about the transplant from the team. In the same way, the transplant team will discuss with you and your family members the procedure and risks associated with the transplant. 

Now, if the doctor gives a green signal for the transplant, but you are somehow unable to find a donor in your family, then the doctor asks you to get registered on the national registry. Getting registered makes the procedure easier. When the organ becomes available, the transplant center will contact you soonest. Therefore, you must give provide your contact information on which you are always available.

Factors That Affect The Availability Of Donor

The availability of a donor depends on your:

• Your blood group
• Your number on the waiting list and the urgency of other patients

The waiting time for the transplantation to take place usually gets over after two months when the donor is available. 

You’re ineligible for the transplant if you:

• Have cancer that has spread beyond its origin.
• Have another serious medical ailment.
• Are 60 years or above.
• Require artificial oxygen support.

How the small intestine transplantation takes place

• The transplantation is of about 8-10 hours and takes place under general anesthesia. 
• The procedure begins with the removal of the diseased bowel and then reconnecting blood vessels to the transplanted intestine. 
• The surgeon then connects the transplanted bowel with the GI tract.
• The surgeon also forms an ileostomy, a surgical procedure in which the doctor diverts a portion of the small bowel towards a temporary opening in your abdomen, stoma.
• Intestinal waste passes out of the ileostomy through the stoma into the external pouch. The waste in the pouch helps the medical team to assess the health of the transplanted intestine.
• Depending on your recovery, your doctor may reconnect the bowel and close the ileostomy after a few months. However, this is not always possible. 

Post-operative Risks Associated with the transplant procedure

Like every other surgery, there are risks involved with this transplantation as well.

Advanced surgical procedures, anti-rejection medications, and a better understanding of your immune system by your doctors have increased the chances of successful transplants and survival rates in the past years.

However, some complications may still arise such as:

• Blood clots, thrombosis
• Heart and lung problems
• Rejection of the transplanted organ
• Infection of the small intestine
• Bleeding
• Long-term use of anti-rejection medications such as kidney problems or cancer
• post-transplant lymphoproliferative disorder (PTLD) related to the Epstein-Barr virus which may infect white blood cells that lead to abnormal growths and multiple organ failure, if not consulted immediately. 

Chances of Rejection Post Transplant Surgery

• When your doctor places a new organ in your body, there are chances that your immune system sees it as a threat and starts building antibodies to stop it from functioning properly.
• That’s why your doctor prescribes immunosuppressant medicines to weaken your immune system after the transplant. It needs to be taken over the course of your life to reduce the chances of rejection.
• Graft versus host disease is another type of rejection that occurs when the transplanted organ attacks the cells of the host. This may happen after a few weeks, months, or even years.
• In case of a failed transplant, your doctor suggests you get registered on the waiting list for another transplant.

What is the survival rate of small bowel transplants?

• In the past years, refined surgical treatments, anti-rejection medications have brought a drastic improvement in the success rates for small bowel transplants.
• The one-year survival rate for patients after undergoing a small bowel transplant is above 85% which is high as compared to liver transplant patients.
• The three-year survival rate for small bowel transplant patients is above 70%.

The first small intestine transplantation in humans took place in 1964.

What is the cost of a small intestine transplant in India?

• Depending on the individual’s health and cancer’s severity, the treatment may include surgery, chemotherapy, radiation therapy, or a combination of these treatments. 
• The small intestine transplant cost in India is approximately 40,000 USD that includes two travelers, accommodation, food, treatment, medicines, unknown expenses, nearby sight-seeing post-surgery, etc. 
• The stay is usually 22 days in India including 8 days in the hospital and 22 days outside the hospital. 

Why do People in India Prefer Global Hospital Mumbai for Small Intestine Transplant?

• The hospital is a pioneer in multi-organ transplants, which include kidneys, liver, small intestine, heart, and lung transplants.
• Every year, the Global Team of doctors performs 17,500 surgical procedures.
• This hospital is the center of excellence are Endoscopic Surgery Centre, Hepatobiliary & Liver Surgeries, Surgical & Medical Gastroenterology, Nephrology, Urology, Minimal Invasive Surgery, Bariatric Surgery & Robotic Surgery, Neurosciences, Cardiology, Cardiothoracic Surgery, Oncology, Gynecology, Orthopedics & Joint Replacement Surgery and so on.

About Dr. Gaurav Chaubal

• 
• Dr. Gaurav Chaubal Chaubal has done MS in General Surgery and has worked as a surgical gastroenterologist for over 20 years. 
• Dr. Gaurav Chaubal is the Director of the Liver, Pancreas, and Intestine Transplant Programme, as well as HPB Surgery. 
• He has almost a decade of expertise in performing liver transplants to his credit. 
• Pancreas Transplant, Adult Dual Lobe Living Donor Liver Transplant, Deceased and Living Donor Small Intestinal Transplant, Simultaneous Pancreas Kidney Transplant, Auxiliary Liver Transplant for Paediatric Acute Liver Failure, and Monosegment Graft Transplant for Pediatric Transplants are among his Maharashtra firsts.

Why do People in India Pick Global Hospital Bangalore for Small Intestine Transplants?

• Global Hospital, Bangalore conducts integrated intestinal transplantation and rehabilitation programs serving its patients with world-class treatment and follow-up care with the help of its renowned, well-experienced medical personnel, nursing staff, and other paramedics.
• When required, doctors from other departments coordinate with the team to treat their patients in the finest possible way.
• The medical staff leaves no stone unturned in providing the accurate diagnosis, discussing details with the patients and their families to explain the pre/during/post-procedure.
• The hospital is well-known for performing transplants meeting international standards and with higher success rates. 

About Dr. Mahesh Gopasetty!

• Dr. Mahesh Gopasetty is a qualified transplant surgeon with 15 years of rich experience in performing Living Donor and Cadaveric Donor Liver Transplants, Small Intestine Transplants, Portal HypertensionSurgeries, Kidney & Pancreas Transplants.
• He has performed over 1,600 adult and pediatric liver transplants and more than 100 small intestine transplants.