The Complete Guide to Intestinal and Multivisceral Transplantation

Reviewed by the physicians of Columbia’s Liver Transplant Team, January 2024

Intestinal and multivisceral transplantation is a surgery that removes diseased or malfunctioning organs along the gastrointestinal tract and replaces them with healthy donor organs. It may involve the small and large intestines, liver, pancreas, or stomach.

An intestinal transplant may also be called a small bowel transplant. Multivisceral transplants may also be called multi-organ transplants or combined transplants.

Key Facts

Intestinal and multivisceral transplantation can be used to treat a variety of conditions, such as intestinal failure, short bowel syndrome, cancer, and more.
Certain conditions that lead to intestinal failure may also cause liver failure, so intestinal transplants are frequently associated with liver transplants.
These procedures are often used to help very young children who are born with severe congenital bowel issues.

Purpose

Intestinal and multivisceral transplantations are performed in people with severe gastrointestinal conditions that cannot be treated any other way. This means that the only way for them to have a functioning gastrointestinal tract is to replace their diseased organs with healthy donor organs.

The gastrointestinal (GI) tract refers to the group of organs that make up the digestive system, which is responsible for taking in and processing food and expelling waste. It is made up of the mouth, esophagus, stomach, pancreas, liver, and small and large intestines.

Types of Intestinal and Multivisceral Transplantations

Depending on the condition, there are several types of transplantation surgeries to replace the organs of the GI tract:

Isolated Intestinal Transplantation (Small Bowel Transplant): an isolated intestinal transplant involves removing the diseased portion of the small intestine and replacing it with a healthy small intestine from a donor. This type of transplant is considered for patients with complications caused by intestinal failure, but who do not have liver failure.
Multivisceral Transplantation: this may be considered for patients who have multiple organ failure, including stomach, pancreas, liver, small intestine and/or kidney failure. This type of transplant involves removing the diseased organs and replacing them with healthy organs from a donor.
Modified Multivisceral Transplantation: this may be considered for patients who do not have liver disease/failure, but have organ failure of the stomach, pancreas, small intestine and/or kidneys. This type of transplant involves keeping your own liver, and removing the remaining diseased organs and replacing them with healthy organs from a donor.

Conditions

A number of different conditions can make intestinal or multivisceral transplantation necessary. The following are some of the most common:

Blocked or obstructed intestines (atresia)
Crohn’s disease
Desmoid tumor with intra-abdominal infiltration
End stage liver disease (cirrhosis)
Endocrine tumors
Gardner's syndrome
Gastroschisis
Hirschsprung's disease
Infiltrative diseases leading to intestinal failure (sarcoidosis or amyloidosis)
Megacystis microcolon intestinal hypoperistalsis syndrome (MMIHS)
Mesenteric venous thrombosis or arterial thrombosis
Microvillus inclusion disease
Multiple resections and explorations
Necrotizing enterocolitis
Severe cholestasis induced by total parental nutrition (TPN-IC)
Short bowel syndrome
Vascular abdominal trauma
Volvulus

Many of these conditions are congenital, which means they are present at birth. Because of this, intestinal and multivisceral transplantation surgeries are most often done on very young children.

Procedure

The various forms of intestinal and multivisceral transplantation all involve the removal of donor organs (either the intestines, liver, stomach, pancreas, or some combination), the removal of the diseased organs, and the implantation of the donor organs. Successfully implanting the donor organs requires the surgeon to reestablish all of their veins, arteries, bile ducts, and other vital connections. The entire process will usually take 8 to 12 hours to complete.

The following is the general step-by-step process of an intestinal or multivisceral transplantation:

Preparation: When a patient is matched with donor organs, the transplantation operation will begin as soon as possible. The patient will be asked to come to the hospital for a final physical exam and so staff can start preparing them for surgery.
Anesthesia: Just before surgery, an anesthesiologist will give the patient general anesthesia. This will put them into a deep sleep for the entirety of the operation.
Incision: The surgeon will begin by making a long incision across the abdomen to gain access to the organs. The size of this incision will depend on the patient.
Evaluation: The diseased organs are evaluated for any abnormalities (like an undiagnosed infection) that would prevent a transplantation.
Removal: All existing connections are severed from the diseased organs. The surgeon removes them from the patient.
Implantation: The donor organs are implanted inside the patient. This involves attaching it to their body’s veins, arteries, and any other vital connections.
Closure: When all bleeding is controlled, the surgeon sews the incision closed.

The following are some of the types of doctors that may be involved in an intestinal and/or multivisceral transplantation:

Gastroenterologist: A specialist in diseases of the digestive system.
Transplant Hepatologist: A specialist in the liver, pancreas, and gallbladder.
Pediatric Gastroenterologist/Transplant Hepatologist: A specialist in children with digestive and liver disease.
Transplant Surgeon: A specialist in removing and implanting organs.
Anesthesiologist: A specialist in administering sedatives and anesthetics.
Radiologist: A specialist in imaging organs.

Alternatives

Currently, few alternatives to intestinal and/or multivisceral transplantation exist. While some medications and therapies may be able to delay organ failure or alleviate symptoms, surgery is usually the only viable way to treat gastrointestinal conditions of this severity.

Risks and Complications

Intestinal and multivisceral transplantation are extremely complex operations, which means they come with significant risks. The most common complications include postoperative hemorrhage, vascular leaks or obstruction, and biliary leaks or obstruction.

The following are some other risks associated with intestinal and multivisceral transplantations:

Bile leaks
Depression or anxiety
Donated organ failure or rejection
Increased risk of skin and certain other cancers
Infection
Internal bleeding
Intestinal leaks
Vascular complications

What to Expect Afterwards

Intestinal and multivisceral transplantation can be a life-saving procedure. However, as complex operations, patients may experience a range of outcomes and recovery times depending on the organs transplanted, the severity of their conditions, and their overall health. All patients will also likely have to take some form of medication for the rest of their lives.

Recovery

Typically, patients remain hospitalized for several weeks after surgery. During this time, their transplant team will evaluate them for any signs of possible complications and assist with the recovery process, such as by providing proper nutrition and exercise routines. Afterwards, they can return home to recuperate. This process can take several months to over a year.

Medications

Patients will have to take a variety of medications after their surgery, some for the rest of their lives. In general, these medications can be divided into three categories:

Anti-Rejection: Also called immunosuppressants, these medications weaken the immune system so that it does not reject the new organs.
Anti-Infective: Because the immunosuppressants weaken the immune system, patients will need to take anti-infective medicine to protect against infection.
Miscellaneous: Additional medications may include ones to treat the side effects of the immunosuppressants or help with other medical conditions.

Immediately after surgery, patients will take a combination of these medications. As they heal, the dosage amounts and number of medications will be reduced. By six months, it is normal for patients to only be taking one or two medications. Immunosuppressants will likely have to be taken for the rest of their lives so that their bodies don’t reject their donor organs. If this medication is not taken as prescribed, organ failure may result.

Survival Rates

According to a 2017 study of over 500 intestinal and multivisceral transplantation surgeries, the survival rates for intestinal transplantations were:

One Year: 74 percent
Five Year: 42 percent
Ten Year: 26 percent

The survival rates for intestinal, liver, and pancreas transplantations were:

One Year: 70 percent
Five Year: 50 percent
Ten Year: 40 percent

The survival rates for intestinal and liver transplantations were:

One Year: 61 percent
Five Year: 46 percent
Ten Year: 40 percent

Next Steps

If you or your loved one may benefit from an intestinal or mulitorgan transplant, our Intestinal and Multiorgan Transplant Program can help.We are one of only a few transplant centers in the world to offer these procedures, and our team of dedicated specialists have over two decades’ worth of experience performing them.

Call us at (877) LIVER MD/ (877) 548-3763 or use our online form to schedule an appointment.

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