Bowel transplant - Why small bowel transplants are carried out

A small bowel transplant may be considered for people with bowel failure who develop complications from total parenteral nutrition (TPN).

Bowel failure

Bowel or intestinal failure means a person's bowel isn't able to absorb enough nutrients from food. It is most often caused by either short gut syndrome or a non-functioning bowel.

Short gut syndrome, also known as short bowel syndrome, is where a large part of the small bowel is missing, removed or damaged. It can be caused by:

• volvulus (twisting of the bowel)
• gastroschisis (a birth defect where some of a baby's bowel develops outside the body)
• necrotising enterocolitis (where part of the tissue of the bowel dies)
• surgery to remove a large section of bowel to treat Crohn's disease or bowel cancer

Most people with short gut syndrome will need some parenteral nutrition (when nutrients are provided directly into a vein). In many cases, this can be given at home without causing any significant problems.

However, if you've received all of your nutrition via TPN for a long period of time, there's a risk that potentially serious complications could develop. If this is the case, a small bowel transplant may be considered.

Total parenteral nutrition (TPN)

TPN is where a person receives all their nutrition in liquid form intravenously ‐ i.e. through a tube (catheter) inserted into a vein in the arm, groin, neck or chest.

In some cases, long-term TPN can lead to complications, which can sometimes be life-threatening. These problems include:

• running out of suitable veins to insert the catheters
• an infection where the catheter is inserted, which can spread through the bloodstream and lead to sepsis
• liver disease

A combined liver and small bowel transplant or multiple organ transplant (multivisceral transplant) may be considered for people who have developed liver disease or who have problems affecting several organs.

Read more about getting ready for a small bowel transplant.