About Our Program
In addition to a state of the art facility featuring world class transplant surgeons, we also pride ourselves on our Intestinal Rehabilitation Program. We view transplantation as a last option. We start with rehabilitation and in many cases successfully wean the patient off of Total Parental Nutrition (TPN).
Our program provides the following treatments as part of our multidisciplinary intestinal rehabilitation strategy:
Total Parenteral Nutrition (TPN)
All potential intestinal transplant candidates must require Total Parenteral Nutrition (TPN) prior to transplant. TPN is a way to get nutrition when the intestine can longer absorb nutrients or calories. Doctors first administer TPN intravenously through a central line while the patient is at the hospital. Eventually, patients learn to administer their own TPN. Many patients infuse TPN only at night and lead full lives while on TPN.
While TPN provides liquid nutrition through a catheter or needle that we insert into a vein in the arm, groin, neck or chest, sometimes, you may be able to eat and drink while getting nutrition from TPN.
Changing your diet can be instrumental in improving the lives of those with short gut syndrome and intestinal failure. While you may need TPN in addition to oral intake, following a small bowel diet can greatly improve outputs and electrolyte losses. Our nutritionist specializes in dietary modifications in the population of patients with short gut syndrome.
If you still have some amount of bowel remaining after the procedure, we may prescribe Gattex (Teduglutide) in order to help increase your absorption of nutrients. It is an injectable medication that has been shown to decrease the need for TPN and to help you with short gut absorb nutrition orally. Dr Iyer is one of the experts in the use of Gattex in adult patients with short bowel syndrome and he continues to perform clinical research in this area to improve the lives of many patients with short bowel syndrome.
Bowel lengthening/tapering procedures
We may be able to lengthen the small amount of bowel you have. Lengthening occurs by dividing the bowel and re-connecting it. This allows food to spend more time in the intestine allowing to better absorb nutrients.
An intestinal transplant is a final treatment option for all patients with intestinal failure who develop life-threatening complications from TPN. Intestinal failure occurs when your body can no longer absorb fluids and nutrients through the bowel. This can occur for many reasons, including conditions that cause the bowel to not function properly, or if there is a removal of a large section of intestine.
When your intestine is no longer able to absorb fluids and nutrients, it may be necessary to receive calories, vitamins and electrolytes via TPN.
There are several types of intestinal transplants.
Isolated Intestinal Transplant
After we complete the initial part of the evaluation, we will decide whether it is necessary to move forward with an isolated intestinal or multi-organ transplant.
An isolated intestinal transplant means that a recipient, with or without a colon, will receive a donor’s small intestine. A multi-organ transplant can include stomach, small and large intestine, pancreas, and liver. A patient may need a multi-organ transplant if some of the blood vessels necessary for intestinal transplant are no longer working or if TPN has caused liver damage requiring transplanting a liver in addition to an intestine.
Intestinal - Liver Transplantation
Intestinal-Liver transplantation is for recipients who have irreversible intestinal failure and end-stage liver disease.
A multivisceral transplant includes the stomach, duodenum, pancreas, small intestine, and liver. The transplant may include a kidney if the recipient has end stage renal disease.
The surgical team will discuss each patient’s needs individually upon consultation.
Intestinal Transplant Candidates
Surgeons will perform intestinal transplants for patients with intestinal failure who develop intractable total parenteral nutrition-related complications. We can subdivide the causes of intestinal failure into two groups:
- Short bowel syndrome (frequently a postsurgical condition)
- Functional disorders (e.g. impaired motility or absorptive capacity in the presence of sufficient intestinal length and surface area)
You are not eligible for intestinal transplant if you have heart or lung disease or are not strong enough to handle the rigor of a major organ transplant.