Bowel transplant - Introduction

A small bowel (intestinal) transplant is an operation to replace a diseased or shortened small bowel with a healthy bowel from a donor.

It is a complicated and highly specialised operation that is not commonly performed, although the number of procedures carried out has increased in recent years.

Currently, around 15-20 small bowel transplants are performed each year in the UK.

These procedures are carried out at four specialist centres ‐ Birmingham Children’s Hospital, Addenbrooke’s Hospital in Cambridge, John Radcliffe Hospital in Oxford and King's College Hospital in London.

Why small bowel transplants are carried out

A small bowel transplant is an option for children and adults whose bowel has stopped working properly and who are being fed by total parenteral nutrition (TPN). This is where a person requires all their nutrition to be given through a drip into a vein because their bowel is unable to absorb nutrients from any food they eat.

While many people needing TPN can have this treatment at home without experiencing any significant problems, the long-term use of TPN can lead to serious complications such as liver disease and repeated infections.

A small bowel transplant may be considered when the person has a serious problem with their bowel, but has developed complications from TPN or is unable to tolerate this form of feeding.

Read more about when a small bowel transplant is needed.

Getting ready

Before having a small bowel transplant, you will need a transplant assessment. This involves tests and conversations with a transplant team to check if you are suitable for the procedure.

If you are suitable, you will be placed on a national waiting list until suitable organs from a recently deceased donor become available. You may be contacted at any time by the transplant team, day or night.

How long you have to wait will depend on your blood group, the availability of donors and how many urgent cases are on the list. On average, people wait just under six months for a small bowel transplant.

In some cases, it may be possible for a family member to donate a section of their bowel for transplantation, without you needing to be placed on the waiting list.

Read more about preparing for a small bowel transplant.

The operation

A small bowel transplant is a complicated and difficult operation that takes, on average, around 8-10 hours and is carried out under general anaesthetic.

During the procedure, the surgeon will remove the bowel and connect the transplanted bowel to your blood vessels and digestive tract. They will also form an ileostomy, where part of the small bowel is diverted through an opening in the tummy, called a stoma.

The stoma will allow digestive waste to pass out of your body into an external pouch, and lets the transplant team easily assess the health of your transplanted bowel. Although it is not always possible, the ileostomy may be reversed a few months later.

After the operation

Recovering from a small bowel transplant can take a long time, and you'll probably need to stay in hospital for at least four to six weeks.

While in hospital, you will receive medication to reduce the risk of your body rejecting the new organ; these are known as immunosuppressants. You will be slowly weaned from TPN to eating a normal diet.

After leaving hospital, you'll need to continue taking immunosuppressant medication and have regular check-ups for the rest of your life.

Outlook

Although medication and regular check-ups will be needed indefinitely, a small bowel transplant can allow you to live as normal a life as possible ‐ including working, enjoying hobbies and living independently.

However, due to the risks of surgery and the general poor health of people who are considered for a small bowel transplant, some people will die within a few years of their operation.

Current figures for transplants carried out in the UK between January 1998 and December 2013 show that:

after 90 days ‐ 84% of adults and 88% of children are still alive
after one year ‐ 76% of adults and 72% of children are still alive
after five years ‐ 62% of adults and 51% of children are still alive

However, the outlook for small bowel transplants carried out now is likely to be better than these figures suggest, as medical knowledge and techniques are constantly improving.

Read more about the risks of a small bowel transplant.