There are commonly three types of intestinal transplantation performed:
A. Isolated small bowel transplant.
Isolated Small Bowel Transplantation (SBTx) typically includes the jejunum and the ileum. Occasionally, part of the colon may also be transplanted. Isolated SBTx is recommended when the cause of intestinal failure is primarily the small bowel. Successful SBTx may reverse PN–induced liver dysfunction.
B. Combined liver and small intestine
This type of transplant includes the liver, jejunum, and ileum (may also include the colon), and part or all of the pancreas. In this case, transplant is reserved for candidates with intestinal failure and irreversible liver failure induced by prolonged TPN therapy. Medical presentation in these situations are more likely to include portal hypertension, severe fibrosis, or cirrhosis. picture
C. Multivisceral transplantation
Multivisceral transplantation usually includes stomach, duodenum, jejunum, ileum (colon may also be included), and pancreas. This procedure can be performed either including or excluding liver transplant. When the liver is spared, the native liver (the patient’s own liver) is preserved. This type of transplant is used to treat candidates with:
- locally, aggressive, non metastasizing abdominal tumors.
- pseudo-obstruction and very poor gastric emptying.
- surgically un-reconstructable gastrointestinal tracts (such as encountered in patients with multiple fistulas or congenital GI tract anomalies).