Section 2: Post-Transplant Stay
What should I expect right after my intestinal transplant surgery?
Please note: Not every transplant center will place an ileostomy after an intestinal transplant. Your transplant team will determine the best option for you. It is always best to refer to your transplant center to determine your transplant's exact action plan.
On average, how long is the hospital stay after an intestinal transplant?
After the transplant surgery, you will go into the Intensive Care Unit (ICU) for a few nights, or maybe longer, depending on how you are doing. Once you are stable, you will be moved to the transplant floor.
Everyone is different, and the duration of stay after transplant can vary greatly. On average, patients stay about four weeks post-transplant surgery, but this is very individualized and will vary per transplant center and patient. Your transplant team will determine when it is best to discharge you.
What is an intestinal endoscopy and biopsy?
The only way to monitor for rejection of the transplanted intestine is via a biopsy of the transplanted bowel.
During the procedure, an endoscope is inserted into the stoma and advanced 4-8 inches.
The physician can visualize the transplanted bowel.
A small pen point biopsy, piece of tissue, is taken from the transplanted bowel and analyzed under a microscope to determine if changes indicating rejection are present.
The first biopsy usually takes place 5-10 days after the transplant surgery.
Please note: Every transplant center is different and will have its specific protocols. Some centers may choose only to complete biopsies when a patient shows signs or symptoms of rejection, while others will still do surveillance biopsies regularly. It is best to talk with your transplant team to determine the plan for your care.
Biopsies will be repeated a few times a week while you are in the hospital after transplant, and then the frequency will decrease as time goes on.
Some standard diet protocols are established in the hospital that you will be required to follow after your transplant.
Usually, your transplant team will start you at the beginning with a diet called "clear liquids" and then advance you as tolerated to the final goal of "GI soft."
The naming of the diets is confusing when you start going into detail about the food and drink that is included on each menu.
Your team may start you on tube feeds after your transplant. Your transplant team will determine the best way for you to receive nutrition after transplant and until you can maintain nutritional status on your own without extra support.
For example, pretzels are allowed on a "GI soft diet.
This confuses many patients because it seems as though pretzels are 'hard' food; however, pretzels do not have high fiber content and are easy to digest.
Your Diet Once Discharged
Once you leave the hospital, you may be off PN and finally eating by mouth! If this is the case, your transplant team will determine the best type of diet for you. This can be an exciting time, but can also be scary and unfamiliar for patients who have not eaten by mouth for a long time.
If you find yourself struggling with consuming enough food throughout the day, remember that the best thing to do is to eat small, frequent meals and always have a snack by your side. If you are still struggling, ask your transplant team to consult with an occupational therapist, nutritionist, or speech-language pathologist who may be able to help teach you tips and tricks for eating and drinking.
There may be certain foods and drinks that you will not be able to consume due to medications. The anti-rejection medications you are on can interact with grapefruit juice; thus, you should avoid all products containing grapefruit and grapefruit juice.
Section 1: The Call
What happens when I receive the call for transplant?
Be sure to answer your phone at all times of the day and night.
When a donor organ becomes available, a transplant coordinator will contact you, discuss the offer, and decide whether to accept or reject the organs.
If you accept the organ(s), you most likely will have to go to your transplant center, which may be immediately, or your team may tell you a specific time to come in for surgery. Your team may ask you to stop eating and drinking and will instruct you on which medications to stop or continue.
Organ Donor Risk Factors to Consider
Some of the success of your transplant depends on organ donor risk factors, which include:
- The age, medical, and social history of the donor.
- The condition of the organ/organs once physically looked at by the organ procurement member of your transplant team.
What are deceased donor organs and the two categories?
The organs you will receive will be deceased donor organs. Deceased donor organs are donated organs from a person who has suffered irreversible brain damage and has been declared dead by a doctor. There are two types of deceased donor organs:
Standard Criteria Donor (SCD): Organs from deceased donors who were young and healthy and did not have significant health problems. The cause of death is usually an accident or sudden illness. The organs are expected to function well after they are transplanted.
Expanded Criteria Donor (ECD): A deceased donor that is not considered “standard.” This type of donor may be considered for you based on your disease and how sick you are. At the time of the offer, the surgeon will review this with you and decide whether to accept or reject the offer.
What is a dry run?
Sometimes the transplanted organ is unable to be used, and you may be sent home. This is known as a dry run. This can be disappointing, but you should understand that this is very common before the transplant. The transplant surgeons are looking out for your best interest and will only give you the most suitable organs.
Section 3: Additional Resources
Helpful Downloads from Transplant Unwrapped
Sign-Up or Log-In to Access:
1. Post-Transplant Eating Tips: Guide written by two-time intestinal transplant recipient, Kayla.
2. Hospital Diets: A one-page guide explaining the different categories of hospital diets. Please remember every transplant center will have slightly different names, rules, and protocols.
Transplant Unwrapped: Learn From Others
Learn From Others: Read stories, watch interviews, and listen to audio from numerous members of the intestinal community on a variety of topics.
Useful for This Section: Learn from Others-
Patient Q & A- Part Four: The Waitlist and Getting the Call
Transplant Unwrapped: Support Programs
Support Programs: Visit the Transplant Unwrapped Support Programs page to get your questions answered, speak with others in similar situations, and feel well-supported during your medical journey.