Section 1: Indications for Transplant

What disorders may result in the need for an intestinal transplant?


Intestinal Failure (IF) can develop when your child's small intestine does not provide the necessary long-term nutrition needed to sustain a normal life. This leads to the need for additional long-term nutrition to be delivered through large veins in the body. This is called "Total Parenteral Nutrition" or "TPN." To read more extensively about short bowel syndrome and pediatric gastrointestinal disorders, please visit our page here. Disorders or Conditions That Can Lead to Intestinal Failure: Short Bowel Syndrome, resulting from:

  • Intestinal atresia (lack of development of the intestine).
  • Apple peel syndrome (a rare form of intestinal atresia).
  • Volvulus (twisting of the intestine).
  • Necrotizing enterocolitis (NEC) (inflammation and loss of blood flow to the intestine, leading to severe damage).
  • Gastroschisis (the intestine develops outside of the body).
  • Crohn’s disease (intestine becomes inflamed and scarred, requiring extensive resection, leading to short bowel).
  • Complicated intussusception (part of the intestine is folded into another part and compromises the blood flow to the involved portion of the intestine).
  • Vascular thrombosis (blood clots) or ischemia (lack of blood flow) to the intestine.
  • Tumors, requiring extensive resection of the bowel.
Absorption Disorders: Motility Disorders
  • Chronic Intestinal Pseudo-Obstruction (CIPO)
  • Megacystis Microcolon Intestinal Hypoperistalsis Syndrome (MMIHS)
  • Extensive Hirschsprung’s disease (Total colonic aganglionosis)




At what point might an intestinal or multivisceral transplant be recommended for your child?


If your child's small bowel has permanently failed, also known as intestinal failure, he or she may require an intestinal transplant. Intestinal failure is when the intestine is not able to digest and absorb enough nutrients to support your child's growth and daily function. Children with intestinal failure require the use of parenteral nutrition, or PN, which is the delivery of nutrients through the large veins in his or her body. Intestinal failure alone is not an indicator for intestinal transplant, rather, your child must also have a complication from parenteral nutrition (PN), as noted below. It is usually from long-term use of PN in which these issues occur. In some cases, other factors, such as quality of life, are taken into account when considering intestinal transplant. Each case is individualized and insurance and transplant center approval will vary. Please discuss your child's situation with their team.




What are the three main types of intestinal transplant?


1. Isolated intestinal transplant: This is a transplant in which only the small intestine (jejunum and ileum) is transplanted. 2. Modified Multivisceral Transplant: This is a transplant in which the stomach, pancreas, duodenum, and small intestine (jejunum and ileum) are transplanted. In some cases, the colon may be included. 3. Multivisceral Transplant: This is a transplant in which the stomach, pancreas, duodenum, small intestine (jejunum and ileum), and liver are transplanted. In some cases, the colon may be included. Please note: Multivisceral transplants can also include other organs, such as a kidney, if indicated. Please see below for a visual and more information.




What are the contraindications to intestinal transplant?


The contraindications will ultimately be determined by your transplant team, but in most cases the following will exclude you from receiving an intestinal transplant:

  • Cardiopulmonary deficiency
  • Aggressive malignancy: Your transplant center may consider your cancer aggressive if it forms, grows, or spreads quickly or is unresponsive to conventional cancer treatments, such as chemotherapy and radiation.
  • Some forms of autoimmune disease with poor prognosis as deemed by the transplant center.
  • Acquired Immunodeficiency Syndrome (AIDS).
  • Existence of life-threatening intra-abdominal infections or sepsis.
  • Inadequate social or financial support.




What are the Centers for Medicare and Medicaid Guidelines for intestinal transplant?


These indications are often the result of long-term PN use because of intestinal failure caused by an underlying disease, as noted below. Please note: It is at the discretion of each individual transplant center and team to ultimately determine a patient's candidacy for transplant.





Section 2: Additional Resources

Helpful Download from Transplant Unwrapped


Sign-up or log-in to access: Appointment Checklist: Download this handout to take with you to your child's next doctor's appointment to help you remember all of the essential things to tell them. Be sure to take lots of notes of what they say. This helps you remember and allows you to share the information with caregivers who could not make the appointment!




Helpful Websites: Transplant Websites


Transplant Websites: Find a list of helpful websites with information on organ donation and transplantation.




Listing of Centers


Listing of Intestinal Rehabilitation and Transplantation Centers: Visit this page to find a listing of US intestinal rehabilitation and transplantation programs.




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- Webinars- Indications and Pre-Transplant Evaluation presented by Kayla, two-time intestinal transplant recipient.




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.




Page References


References here.





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Pediatric Indications for Intestinal Transplant

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Three Main Types of Intestinal and Multivisceral Transplant

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