Recently the news has been flooded with how the Delhi rape victim has been offered an intestinal transplant by Sir Gangaram Hospital. The offer was communicated by D.S. Rana, the Chairman of Sir Gangaram Hospital who said that the private hospital has performed India’s first and only living donor intestinal transplant which has been reported in peer reviewed journal this year.
So what is an intestinal transplant? Why does she need it? Will it work? Here are some things you need to know about intestinal transplants.
Intestinal transplantation has evolved in the past decade from being considered an ‘experimental’ procedure to what is considered as a last-resort treatment option for patients with intestinal failure who develop life-threatening complications from total parenteral nutrition (TPN). Long-term TPN can result in complications including bone disorders, catheter-related infections and liver failure. Over an extended period of time, TPN also can damage veins used to administer the nutrition via the catheter. The procedure has shown an advancement in number of surgeries performed without complications due to the advancement of techniques relating to organ preservation, surgical technique, immunosuppression, and postoperative management.
Why is it needed?
Transplantation is the only treatment available for patients diagnosed with irreversible intestinal failure in the short gut syndrome (a mal-absorption disorder, in which removal of the small intestine is necessary), defective intestinal motility ( when the intestines are not able to move food through the gastrointestinal tract) or in cases where the intestines need to be removed in part or totally due to cancer or trauma.
Without a transplant, patients with intestinal and liver failure have an expected median survival of 6 – 12 months while continued on TPN.
An Intestinal transplant is a complex surgery, which requires a highly skilled multidisciplinary transplant team. A transplant surgery usually takes about 3-4 hours, where as if the patient requires multi organ transplant the procedure might take upto 12 hours. Either the small bowel or intestine is transplanted in isolation, or can be transplanted with the liver and/or other gastrointestinal organs.
Intestinal Transplant Procedure
In this procedure the intestine and other diseased organs are replaced with healthy donor organs. The blood vessels of the patient and donor are connected to establish blood supply to the transplanted intestine. The donor organs are then connected to the patient’s intestine.
Usually an ileostomy is then performed. It is a surgically created opening through which the ileum (a section of the patient’s small intestine), is brought up through the abdominal wall. This opening allows the waste from the body to directly pass out of the body. This procedure is important for transplant patients because it allows doctors to keep a close eye on the patient’s progress. In time, the ileostomy is closed. A feeding tube is also placed into the stomach to help the patient transition to an oral diet.
Post Transplant Complications:
The commonest complications from a transplant are infections due to the high doses of immunosuppressive medication, rejection of the transplant and/or intestinal ischemia and leaks from the anastomoses due to surgical technical difficulty in reconnection of the intestine and the vessels.
Care after an intestinal transplant differs slightly for each patient, depending on their medical history, type of transplant and medical condition at the time of their transplant. The length of stay in the hospital varies for each patient, but can last for several weeks or as long as several months.
Immediately after a transplant the patient is shifted to the ICU and is closely monitored. After he/she has stabilised and shifted out, close monitoring is required to prevent bacterial, fungal and viral infections. Some patients also may require blood pressure, diabetes or anti-ulcer medications. It is important to remember that an intestinal transplant is not a surgical cure, but rather a last-resort therapy that requires meticulous administration of medication and close monitoring to be successful. We hope this helps our Delhi rape victim to lead a healthy life!