Types of Procedures

Intestine transplantation comprises 3 types of operative procedures that are adapted to the needs of the patient. These procedures include isolated small bowel transplantation, a composite graft of the liver and small bowel, and a multivisceral transplant including the small bowel with liver, stomach, and/or pancreas.

Isolated Intestine transplantation

Isolated intestine transplantation is indicated for patients with irreversible intestinal failure requiring permanent TPN to meet nutritional needs. Criteria for timely transplantation include the diagnosis of intestinal failure with deteriorating liver function secondary to TPN cholestasis, limited central line access, and multiple episodes of line sepsis.

Combined Small Bowel-Liver Transplantation

Combined small bowel-liver transplantation is recommended for patients with irreversible failure of both the liver and small bowel. In this situation, the patient has intestinal failure as well as severe hepatic dysfunction, usually from TPN-induced cholestasis, as evidenced by cirrhosis and associated symptoms of end-stage liver disease.

Multivisceral Transplantation

Multivisceral transplantation is considered when patients have irreversible failure of 3 or more abdominal organs including the small bowel. The most common indications for multivisceral transplantation are total occlusion of the splanchnic circulation, extensive GI polyposis, hollow visceral myopathy or neuropathy, and some abdominal malignancies.[50]

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