What to know …

Purpose

IT and MVT are performed in people with severe gastrointestinal (GI) conditions that cannot be treated any other way. The GI tract refers to the group of organs that make up the digestive system.

 

Types of IT and MVT 

Depending on the condition, there are several types of transplantation surgeries to replace the organs of the GI tract:

  • Isolated IT (Small Bowel Transplant (ISB)): involves removing the diseased portion of the small intestine and replacing it with a healthy small intestine from a donor.
  • MVT: this may be considered for patients who have multiple organ failure.
  • Modified Multivisceral Transplantation(mMVT): this may be considered for patients who do not have liver disease/failure but have organ failure.

 

Conditions

The following are some of the most common conditions that can make IT and MVT necessary:

  • Blocked or obstructed intestines (atresia)
  • Crohn’s disease
  • Endocrine tumors
  • Hirschsprung's disease
  • Multiple resections and explorations
  • Severe cholestasis induced by total parental nutrition (TPN-IC)
  • Vascular abdominal trauma

 

Many of these conditions are congenital, which means they are present at birth. Because of this, IT and MVT surgeries are most often done on very young children, but not always.

 

Procedure

The various forms of IT and MVT all involve the removal of donor organs, the removal of the diseased organs, and the implantation of the donor organs. Successfully implanting the donor organs requires the surgeon to reestablish all of their veins, arteries, bile ducts, and other vital connections. The entire process will usually take 8 to 12 hours to complete.

The following is the general step-by-step process of an IT or MVT:

  1. Preparation: When a patient is matched with donor organs, the transplantation operation will begin as soon as possible.
  2. Anesthesia: This will put the patient into a deep sleep for the entirety of the operation.
  3. Incision: Along incision across the abdomen to gain access to the organs.
  4. Evaluation: The diseased organs are evaluated for any abnormalities that would prevent a transplantation.
  5. Removal: All existing connections are severed from the diseased organs.
  6. Implantation: The donor organs are implanted inside the patient.
  7. Closure: When all bleeding is controlled, the surgeon sews the incision closed. 

The following are some of the types of doctors that may be involved in an IT and/or MVT:

  • Gastroenterologist: A specialist in diseases of the digestive system.
  • Transplant Hepatologist: A specialist in the liver, pancreas, and gallbladder.
  • Transplant Surgeon: A specialist in removing and implanting organs.
  • Anesthesiologist: A specialist in administering sedatives and anesthetics.
  • Radiologist: A specialist in imaging organs.

 

Alternatives

Currently, few alternatives to intestinal and/or multivisceral transplantation exist. While some medications and therapies may be able to delay organ failure or alleviate symptoms, surgery is usually the only viable way to treat gastrointestinal conditions of this severity.  

 

Risks and Complications

IT and MVT are extremely complex operations, which means they come with significant risks. The most common complications include postoperative hemorrhage, vascular leaks or obstruction, and biliary leaks or obstruction. 

The following are some other risks associated with IT and MVT:

  • Bile leaks
  • Depression or anxiety
  • Donated organ failure or rejection
  • Increased risk of skin and certain other cancers
  • Infection (Sepsis)
  • Internal bleeding
  • Intestinal leaks (Leaky Gut)
  • Vascular complications

 

What to Expect Afterwards

IT and MVT can be a life-saving procedure. However, as complex operations, patients may experience a range of outcomes and recovery times depending on the organs transplanted, the severity of their conditions, and their overall health. All patients will also likely have to take some form of medication for the rest of their lives. 

 

Recovery

Typically, patients remain hospitalized for several weeks after surgery. During this time, their transplant team will evaluate them for any signs of possible complications and assist with the recovery process, such as by providing proper nutrition and exercise routines. Afterwards, they can return home to recuperate. This process can take several months to over a year.

 

Medications

Patients will have to take a variety of medications after their surgery, some for the rest of their lives. In general, these medications can be divided into three categories:

  • Anti-Rejection: Also called immunosuppressants, these medications weaken the immune system so that it does not reject the new organs.
  • Anti-Infective: Because the immunosuppressants weaken the immune system, patients will need to take anti-infective medicine to protect against infection.
  • Miscellaneous: Additional medications may include ones to treat the side effects of the immunosuppressants or help with other medical conditions.

 

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