One of only a few well-established programs in intestinal transplantation, Mount Sinai’s Intestinal Failure and Transplantation Program, also referred to as the Small Bowel Transplant Program, has become a national referral center for adult and pediatric patients with irreversible intestinal failure. Because of the intense technical difficulties of the operation, which lasts from 8-12 hours, very few centers in the United States perform this procedure. Medicare has designated Mount Sinai one of only three centers in the country eligible for its coverage.

Patients who develop intestinal failure as a result of disease, injury or congenital abnormalities are unable to absorb nutrition or fluids from their intestinal tract. These patients need to be fed intravenously via a therapy called total parenteral nutrition (TPN). Even though some patients who are stable on TPN may be able to remain on it for a long time - with lifestyle restrictions - the chance of dying from life-threatening complications (i.e., liver failure) increases over time and with the number of episodes. Presently, intestinal transplantation is the only alternative available to them. With an interdisciplinary approach, services offered in the program include the management of home intravenous nutrition, intestinal rehabilitation, remedial autologous gut salvage surgery and intestinal transplantation.

What makes the Intestinal Failure and Transplantation Program unique is its comprehensive approach to intestinal failure, integrating all available treatment options for the patient before choosing the intestinal transplantation. Some patients benefit from attempts at intestinal rehabilitation using novel medical and non-transplant surgical strategies or even simply optimization of long term TPN.

The first part of the patient evaluation consists of a meeting with a gastroenterologist/hepatologist transplant surgeon, nursing coordinators, a nutritionist and a social worker to discuss the patient’s medical condition and history provided by the referring physician. Patients who receive a successful transplant can return to a near normal diet and no longer need to be on TPN, but they have to take immunosuppressive medications for life.

In intestinal transplantation, the patient usually receives the entire samll intestine from a deceased organ donor. For pediatric patients, innovative technical approaches allow us to use larger donors and thus reduce the waiting time and the risk of mortality on the waiting list. Our expertise in managing even relatively advanced parenteral nutrition associated liver disease allows us to perform isolated intestinal transplants in most cases and enjoy superior outcomes.

Called most innovative among the Mount Sinai transplantation programs, the Intestinal Failure and Transplantation Program offers three types of transplants-- The Isolated Intestine transplant, the Liver-Intestine transplant and the Multi-Visceral transplant.

After a patient is approved for intestinal transplantation, he/she will be placed on the transplant waiting list until a suitable organ becomes available, and will be closely monitored during the waiting period by the Mount Sinai Intestinal Failure Team. After transplantation, the patient will be hospitalized at Mount Sinai for a an average period of four to six weeks.

During this recovery period, the patient will be switched from TPN to enteral (by mouth) nutrition and will be carefully monitored by physicians of the transplant team. The team will prescribe and adjust immunosuppressive medications, perform frequent endoscopies to diagnose possible rejection of the transplanted organ, and will reverse rejection if it occurs. During the transplant procedure, a temporary ileostomy (an opening in the skin through which bowel contents are emptied into a bag) is created to allow us to monitor the transplanted bowel using a flexible camera (endoscope). This ileostomy is typically closed about 6 to 12 months after transplant.

In order for the intestinal transplant to be successful, it is crucial that the patient be closely monitored by the Mount Sinai transplant team after discharge from the hospital via frequent follow-ups. New medications to avoid rejection will be prescribed by the team, and six to twelve months after discharge the ileostomy will be surgically closed or removed. Following this procedure, the periodic follow-ups may be carried out by the referring physician in consultation with the transplant team. Even after the patient resumes normal activities, the Mount Sinai transplant team will continue to be involving in monitoring the patient’s blood levels of medications and post-transplant medical condition.

Mount Sinai has come a long way in the treatment of intestinal diseases, and in improving the quality of patients’ lives, since the days when one of its pioneering physicians, Dr. Burrell Crohn, in 1935, discovered and described inflammatory bowel disease (IBD) in a patient - thereafter named Crohn’s Disease. Prior to the development of intestinal transplantation - started at Mount Sinai in collaboration with other medical centers – critically ill intestinal failure patients – for whom TPN failed - had no other life-preserving treatment option.