Small Bowel Transplant: A Lifesaving Option for Intestinal Failure

The small intestine does a lot more than most people realize. It breaks down the food we eat and helps the body absorb the energy, nutrients, vitamins, and minerals we need to stay healthy. But when the small intestine stops working properly, or large parts of it have been removed, the body can no longer get enough nutrition on its own. This is called intestinal failure. In some cases, when it becomes clear that the intestine can’t recover or function long-term, doctors may recommend a small bowel transplant as a way to restore nutrition and give the person a better quality of life.

When intestinal failure is irreversible, patients often rely on total parenteral nutrition (TPN) to receive most or all of their required nutrients and calories. TPN is delivered through a catheter inserted into a large vein, typically in the arm, neck, chest, or groin. While TPN can support life for several years, its long-term use carries risks, such as recurring infections, blood clots, liver damage, electrolyte imbalances, and deficiencies in essential micronutrients.

Due to these potential complications, TPN is best managed in specialized hospitals that have experience in minimizing infection risks and managing long-term outcomes. These centers can help improve the quality of life and extend survival for patients dependent on TPN.

What is a Small Bowel Transplant?

A small bowel (intestinal) transplant is a surgical procedure that replaces a shortened or non-functioning small intestine with a healthy one from a donor. In some cases, surgeons also transplant additional organs such as the liver, pancreas, stomach, or large intestine along with the small bowel. When more than just the small bowel is involved, the procedure is called a multivisceral transplant (MVT).

Surgeons may include the liver in the transplant if the patient has long-term liver damage caused by total parenteral nutrition (TPN), which can lead to liver fibrosis or cirrhosis. The pancreas is often included because it connects directly to the small bowel, and its inclusion can simplify the surgery. The stomach and large intestine may also be added if previous surgeries have damaged these organs.

Small Bowel and Multivisceral Transplant – Who Needs It?

Small bowel and multivisceral transplants are highly specialized surgeries performed in only a few expert centres around the world. They’re still relatively rare, but the number of these procedures has been steadily increasing in recent years.

Most small bowel transplants come from deceased (cadaveric) donors. However, because of the need for careful matching to lower the risk of rejection, patients often have to wait a long time for a suitable donor. During this time, they typically stay on TPN (total parenteral nutrition)for their nutritional needs. In some rare cases, a small bowel can be donated by a living person, but because this carries significant risks for the donor, it’s not commonly done.

Not everyone with intestinal failure is a candidate for a transplant. Due to the complexity and demands of the surgery, only certain patients are considered. Each case undergoes a detailed evaluation process conducted by a multidisciplinary team. This team usually includes a physician, surgeon, anaesthetist, nutrition specialist, endoscopist, and other healthcare professionals.

What to Expect After a Small Bowel Transplant?

The main goal of a small bowel or multivisceral transplant is to improve both the quality and length of a patient’s life. After a successful transplant, most patients can start eating again within about a week. They begin with small portions, which are gradually increased based on how well the new bowel is healing.

In the early recovery period, patients will need to take several medications. These help with healing and preventing complications. Over time, the number of medications usually goes down. Regular monitoring is also important. This includes endoscopy to check the bowel and make sure there are no signs of rejection.

For some patients, the transplant may not lead to full independence from nutritional support. They might still need part of their nutrition through line feeds, especially in the early months. This can change over time as the bowel adapts and becomes more efficient.

A key part of post-transplant care is taking immunosuppressive medications. These drugs help prevent the body from rejecting the new bowel by reducing the immune system’s response. They need to be taken for life. Although they can increase the risk of infections and some cancers, these risks are often much lower than the risks of continuing to live with severe intestinal failure and long-term TPN.

Life Expectancy of a Small Bowel Transplant

Survival rates after a small bowel transplant have been steadily improving. Current data indicate that approximately 70 to 80 percent of patients survive for at least one year after the procedure. In some cases, studies have reported one-year survival rates of up to 85 percent. Three-year survival rates are around 70 percent, and long-term outcomes continue to improve. Five-year survival rates now average around 50 to 60 percent, depending on the patient group and the center performing the transplant.

Frequently Asked Questions