Intestinal Transplant Program

The Intestinal Transplant Program at Cincinnati Children’s provides comprehensive, innovative care for patients with short bowel syndrome, congenital enteropathies and pseudo-obstructions. With a one-year post-transplant survival rate of 100% according to the Scientific Registry of Transplant Recipients, our surgical outcomes are among the best in the United States.

Innovative Treatment Approach

Innovation is a hallmark of our program’s success. For example, our team:

• Offers sophisticated surgical techniques to help patients with Hirschsprung’s disease, pseudo-obstruction and motility issues achieve bowel control following transplant
• Proactively includes the colon in composite grafts
• Employs state-of-the-art techniques for treating graft vs. host disease, and has achieved excellent results with graft salvage for patients recovering from severe exfoliative rejection
• Follows stringent protocols for preventing and treating infectious diseases, and is one of only a few intestinal transplant programs with a full-time infectious disease specialist
• Pioneered the widely used “Cincinnati low-dose chemotherapy regimen” for post-transplant patients with Epstein-Barr virus-associated post-transplant lymphoproliferative disease
• Was among the first to work intimately with home health care providers to ensure a safe environment following hospital discharge
• Creates a “patient care passport,” an invaluable resource for families and physicians that details all significant clinical events related to the patient’s intestinal transplant care

Optimizing Surgical Outcomes

Transplant surgery is considered a last resort. Some patients are able to avoid it by participating in our Intestinal Rehabilitation Program, which offers extensive treatment options and training to help patients manage their long-term medical needs. Other patients have the option of undergoing autologous intestinal reconstructive surgery (like bowel lengthening and tapering) in order to preserve bowel function and avoid transplant.

When a transplant is necessary, our team utilizes effective strategies to improve outcomes. Examples include:

• Placing the patient on the transplant list as quickly as possible
• Initiating pre-transplant therapies to address issues such as frequent blood stream infections or previously undiagnosed heart disease and renal insufficiency
• After surgery, using rigorous protocols to identify early signs of rejection and organ failure
• Working with families, referring physicians and home care providers to ensure that long-term follow-up care is in place
• Providing extensive education and training so that parents can care for their child at home

Types of Intestinal Transplantation

Isolated Small Bowl Transplant

Our team is very skillful in preserving central venous catheters and maintaining adequate access to IV nutrition. In addition, we are very skilled at preventing life-threatening complications of blood stream infections. However some children come to us after having lost many central venous catheters and they are at risk for losing all of their access for intravenous nutrition. Others have suffered more than one infection that has threatened their lives and caused many of their organs to "shut down" Those patients need to come off TPN as soon as possible and isolated small bowel transplantation can facilitate getting them off intravenous nutrition. Yet another group of patients is born with bowel disorders that result in massive loss of salt and fluid. These children may lose their lives if their intravenous fluids are interrupted for more than a few hours. They are at such risk that they need small intestinal transplantation as well. When an isolated intestinal transplant is considered, the native stomach, small bowel, and liver are maintained and the only organ transplanted is the small intestine.

Small Bowl /Liver / Pancreas Transplant

In past years, one of the most devastating complications of IV nutrition was liver failure. However, because our team initiated important treatment innovations over the past 10 years, the risk for liver failure has declined considerably. Unfortunately, a few patients receiving intravenous nutrition will develop liver failure despite our best efforts. When liver failure complicates intestinal failure, we transplant the liver along with the intestine. The donated pancreas is also transplanted because it is more dangerous to attempt to remove it than to keep it in place.

Multi-Visceral Transplant

Because some patients have disorders of the nerves or muscles of the gastrointestinal tract, the movement of food down the gastrointestinal tract may be so disorganized that they develop intestinal failure needing intravenous nutrition. In those situations, complications such as liver failure, loss if central venous access and life-threatening blood stream infections may occur. When they do occur, some transplant programs remove the patient's stomach, duodenum, the rest of the small and large intestine, and possibly the liver, replacing all of them with new organs. This procedure is called a multi-visceral transplant or a modified multi-visceral transplant. Our team prefers to leave intact a small amount of native stomach and to sew it directly to the transplanted small intestine. The excellent results we have enjoyed leaving in part of the native stomach prompt us to avoid multi-visceral transplantation if possible.

When is an intestinal transplant needed?

Intestinal transplants are sometimes needed due to:

• Chronic intestinal pseudo-obstruction
• Congenital enteropathies, including tufting enteropathy and microvillus inclusion disease
• Crohn’s disease following extensive small bowel resection
• Desmoid tumors of the abdomen necessitating extensive small bowel resection
• Gastroschisis
• Hirschsprung’s disease
• Intestinal atresia and stenosis
• Intestinal malrotation and volvulus
• Necrotizing enterocolitis
• Surgical short bowel syndrome
• Trauma

What is Involved in an Intestinal Transplant?

• Evaluation: Patients will come to Cincinnati Children's Hospital Medical Center for a week-long admission to undergo testing to determine if they are a candidate for small bowel transplantation.
• Listing/Donor Matching: The transplant team works with the local and national transplant lists to find an appropriate organ(s). Organ allocation is based on medical urgency, time on the waiting list and blood type compatibility.
• Surgery: The transplant surgeon removes the donor organ, removes the recipient's damaged small bowel and then attaches the new donor small bowel.
• Recovery: Most small bowel transplant recipients spend several weeks in the hospital. This is longer than for other types of organ transplant. The team will monitor the recipient for rejection, infection and other complications.