Small bowel/multi-visceral transplants

As a last resort when no other option is available and the patient faces a high liklihood of death, a multi-visceral transplant may be necessary. Multi-visceral transplants involve the transplantation of the stomach, small bowel, duodenum, and pancreas. In many instances, the liver is also transplanted.

Preparation:

There are many tests that will be conducted before a patient is approved for a transplant. Typically, testing requires a 1-2 week stay near the medical center where it will be performed. After all the testing is completed, the transplant team evaluates the results to determine if the patient is a candidate or if there are other options.

Once approved, the patient will be placed on a waiting list for when organs become available. The call may come at any time. Sometimes it is that same day, other times it may take up to several years. This typically depends on blood type, size of organs needed, length of list, urgency, health of patient at the time organs become available, quality of organs, and many other factors.

Before the procedure:

Once the call is received, the patient is instructed to immediately return to the transplant center where he/she will remain for hours as the organs are harvested and evaluated. If they are a good match, the surgery will proceed.

During the procedure:

The small bowel, pancreas, stomach, and duodenum are removed. They are then replaced with the donor organs within a certain amount of time. If a liver is needed, it is the last organ transplant and there is an extremely limited timeframe in which this must be done in order to prevent death. Typically, the surgery takes anywhere from 15-24 hours.

After the transplant:

The patient is moved to an intensive care unit where he/she will remain until stable enough to move to the main floor. Average stay in the ICU immediately post-transplant is 5 days to a week. The patient remains on multiple IV antibiotics, anti-rejection meds, TPN, and many IV infusions of the course of several weeks. He/she will have an NG tube or g-tube, drains, ostomy, and possibly other devices. PT is usually started in the hospital, and with time, small amounts of liquid food is allowed and then soft solids. Eventually, patients are able to tolerate more solid foods. The healing process is ongoing an individualized for everyone. Patients will remain on anti-rejection meds, antibiotics, vitamins, minerals, and other medication for life. Ostomy reversal is possible a year or two after the transplant.

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