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The Multi Organ Transplant Program of the Toronto General Hospital began performing small bowel transplants in January, 2000. Depending on the medical diagnosis, the patient may require a small bowel transplant alone, a small bowel and liver transplant, or a small bowel, liver, pancreas and stomach transplant (also known as a multi-visceral, or cluster transplant). Indications Small bowel transplantation can be considered when patients with poor intestinal function do not respond to standard therapy, which usually includes parental nutrition (TPN). Some of the signs and symptoms of small bowel failure are:
Conditions that can lead to intestinal failure include:
There are three general types of small bowel failure.
Assessment Pre-transplant evaluation consists of a variety of medical tests and interviews with members of the transplant team. This process is essential in determining a patient's suitability for small bowel transplant. During the evaluation process the potential candidates and their family will be provided with information to assist them in making informed decisions about the operation and post-operative period. The patient and their family are encouraged to ask questions of the team members and meet the candidates awaiting transplant as well as those having received a previous transplant if possible. The workup process typically involves the following tests, but may require additional testing if other health issues are of concern:
The Transplant Team Members who consult on small bowel transplant evaluation are:
Waiting List There are approximately 10 patients on the waiting list for small bowel transplant within our program. The waiting period for a donor varies in length because the donor pool is limited and the selection criteria for a matching donor are strict. Surgery Small Bowel transplant surgery is a complex procedure and may take up to 16 hours. The operation consists of removing the diseased small bowel, transplanting the small bowel, creating an ileostomy, and placement of a feeding tube. Recovery Small bowel transplant recipients can expect to be in the hospital for several weeks after surgery. After the transplant procedure, patients are usually ventilated and monitored hemodynamically in the intensive care unit. Once stabilized and extubated, patients are then transferred to the Multi Organ Transplant Unit. Patient care following transplantation focuses on:
Discharge & Follow-up Discharge planning begins well in advance and patients meet with a social worker during their initial assessment to addressing these issues early. The program's Patient Resource Coordinator assists in assessing patients' readiness for discharge and ensuring patient teaching is complete. Patients will return to the Ambulatory Care regularly after the initial postoperative period, with the frequency of clinic visits reduced as the patient's condition permits. During clinic appointments, patients are seen by their Transplant Coordinator, and Transplant Physician. Communication with the patient's family physician and other specialists is an important component of follow-up care. Patients keep in contact with their transplant team through our patient voicemail system, Easy Call. The Multi Organ Transplant Program's team approach ensures that patients receive comprehensive follow-up care after transplantation and throughout their lives post-transplant.
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