Intestinal Transplant Options for Children
An intestinal transplant has the potential to greatly improve the quality of life for some patients with intestinal failure. As one of just a few centers nationally that perform pediatric intestinal transplantation, the Intestinal Transplant Program at Cincinnati Children’s provides comprehensive, innovative care for your child. Our advanced treatment approaches and surgical expertise have made us one of the largest and most accomplished centers in the nation for these procedures.
Your child may need an intestinal transplant if they cannot digest food or absorb fluids. Intestinal transplants are sometimes required due to conditions like:
- Congenital diarrheal disorders
- Gastroschisis
- Hirschsprung disease
- Intestinal atresia and stenosis
- Intestinal malrotation and volvulus
- Necrotizing enterocolitis (NEC)
- Short bowel syndrome
- Small bowel motility disorders
Why Choose Us?
Coordinated, Family-Centered Care for Complex Conditions
Our team is experienced in caring for children with complex medical histories, including those who may require multi-organ transplants. The intestinal transplant team collaborates with experts across Cincinnati Children’s—including gastroenterologists, pathologists, infectious disease specialists, mental health professionals and more—to provide complete care for your child’s health.
With so many specialists involved in your child’s care, our nurse coordinators will manage scheduling appointments so your child can see as many providers as possible during one visit. An intestinal transplant can also mean a long hospital stay for your child. That’s why Cincinnati Children’s offers numerous resources to ease your family’s stay, including the Family Resource Center and Ronald McDonald House.
Improved Outcomes for Transplant Recipients
With our collaborative and innovative team approach to care, our one- and three-year post-transplant patient and graft survival rates are among the best in the United States. Our transplant team works across specialties to improve these outcomes for children who need intestinal transplants by:
- Placing your child on the transplant list as quickly as possible
- Beginning pre-transplant therapies early to address risk factors, existing medical conditions and complications like bloodstream infections, heart disease and renal insufficiency
- Practicing rigorous protocols after surgery to prevent organ rejection
- Offering comprehensive support after discharge, including education for families and collaboration with home care providers and referring physicians, to ensure long-term success
Innovative Treatment Approaches
Our team is dedicated to finding the latest treatment options and innovations to give your child the best outcomes. These include:
- Incorporating the colon as part of some intestinal grafts, which aids in retaining water, absorbing calories and helping bowel movements, to improve quality of life
- Preventing and treating transplant complications, including state-of-the-art techniques to manage graft vs. host disease, and the “Cincinnati low-dose chemotherapy regimen” to treat Epstein-Barr virus-associated post-transplant lymphoproliferative disease (PTLD)
- Following stringent protocols to prevent and treat infectious diseases as one of only a few programs nationally with a dedicated infectious disease specialist
- Utilizing Gattex, a specialized medication, to improve intestinal absorption post-transplant
Integrated Relationship with Intestinal Rehabilitation
Our team works closely with patients at the Intestinal Rehabilitation Center at Cincinnati Children’s. The experts at this center strive to improve your child’s GI health before transplant by addressing any underlying conditions and risk factors. We partner with surgeons who are skilled in intestinal reconstructive surgeries like bowel lengthening and tapering to preserve bowel function, which may help prevent the need for intestinal transplant altogether.
Even with intestinal rehabilitation, your child may still need an intestinal transplant if their surgeon can’t reconstruct their GI tract, if they have repeated central venous catheter infections that prevent nutrition access, or if they have end-stage liver failure from intestinal failure-associated liver disease.
Types of Intestinal Transplantation
- Isolated small bowel transplant: Isolated small bowel transplantation involves replacing your child’s intestine with one from a donor while preserving other organs. Your child may benefit from this transplant if they have complications from IV nutrition, such as infections, or if they have bowel disorders that lead to massive fluid loss. This transplant could help your child absorb nutrition with less reliance on IVs.
- Small bowel/liver/pancreas transplant: Some patients receiving IV nutrition may develop liver failure alongside intestinal failure. In these cases, we transplant the liver, intestine and pancreas together.
- Multi-visceral transplant: Some patients who experience significant complications from their GI conditions may require multi-organ transplantation to remove part of their stomach, duodenum, small and large intestine, and, in some cases, the liver. While some hospitals will remove the entire stomach as part of a multi-visceral transplant, surgeons at Cincinnati Children’s have seen excellent results in preserving part of the stomach to connect to the transplanted small intestine.
What to Expect
- Evaluation: Before placing your child on the transplant list, the care team will conduct a thorough set of tests to determine if your child is a candidate for intestinal transplant. This evaluation process can take up to a week and includes appointments for imaging and bloodwork as well as consultations with transplant surgeons, transplant medical doctors, social workers, clinical psychologists, dietitians, pharmacists and transplant finance specialists.
- Listing and donor matching: Once approved for transplant listing, your child will be placed on the national organ transplant waitlist. Organ allocation is based on medical urgency, time on the waiting list and blood type compatibility.
- Surgery: When an organ match is found, your child’s surgeon will remove and evaluate the donor organ. They will then remove your child’s damaged organ(s) and replace them with those from the donor. Depending on the type of transplant your child is receiving, surgery can take up to 12 hours or longer.
- Recovery: Most small bowel transplant recipients spend several weeks or months in the hospital so your child’s care team can monitor for organ rejection, infection and other complications. This stay is longer than for other types of organ transplants to ensure that your child is receiving adequate nutrition for growth and development.
