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Health: Intestines are dificult to transplant

dixitrm200 Senior Member

Joined: 05 January 2013
Posts: 476

Posted: 08 January 2013 at 4:07am | IP Logged
    What is intestinal failure and what happens after it?

    Intestinal failure is defined as reduction in functioning length of small intestine below a certain limit, which causes inability to digest and absorb nutrients and fluid, required for adequate maintenance of an individual. Most cases of intestinal failure are due to 'Short Gut Syndrome' which is due to surgical resection leading to loss of functioning mass of small intestine. The small intestine is a muscular tract that follows the stomach. This is the place where most of the digestion and absorption of food, fluids, electrolytes and nutrients takes place. Any problem in proper functioning of the small intestine can make a person dehydrated and malnourished. Intestinal failure can also cause diarrhoea, muscle wasting, poor growth, frequent infections, weight loss and fatigue.

    How does a person survive after the removal of small intestine?

    In case of failure of small intestine the usual process of eating and digestion cannot take place and hence parenteral nutrition (PN) is used to feed the patient. The feeding is done intravenously. Depending on the person's needs, PN formula is made. The process is called total parenteral nutrition (TPN) when no significant nutrition is obtained by other routes.

    Is TPN a permanent solution?

    A patient with intestine failure can meet nutritional requirements through TPN. It is observed that patients can live on TPN for many years. However, dependency on this process of feeding can impair normal life. Patients in whom more than 75% of functional intestinal length is removed surgically may have permanent dependence on TPN and thus higher incidence of associated complications. Intestinal transplantation should be offered to such individuals.

    How is intestinal transplant done?

    A transplant requires surgical removal of small intestine and its replacement with a healthy organ. There are three main types of intestinal transplantation : (i) isolated small intestine; (ii) combined liver & intestine; and (iii) multivisceral, which contains small intestine with stomach, duodenum, pancreas, with/without liver.

    Why is intestine transplant so complicated?

    Before 2001, intestinal transplant was largely considered experimental. In the past decade it is evolving as a standard care for patients with intestinal failure. When compared to liver and kidney the intestine is a difficult organ to transplant, as it affects the immune system. There are very few attempts to perform intestinal transplant in India, hence no definite success rate is known, however 1 year and 3 year survival is reported to be close to 80 % and 67% in the Western countries. 

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