ADVANCED CARE
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Intestinal & Multivisceral Transplants

When irreversible intestinal failure and life-threatening PN complications make transplantation a critical option

Types → When Considered → Support →
Medical disclaimer
This page is educational only. Transplant decisions are complex and belong with specialized transplant teams. SBSF does not recommend or endorse specific centers or procedures.

Intestinal transplantation is a highly specialized surgical option for irreversible intestinal failure. When long-term parenteral nutrition leads to life-threatening complications — such as liver failure or loss of central venous access — transplantation may become a critical therapeutic path.

HISTORY & EVOLUTION
How the field advanced
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1960s — early attempts

First human intestinal transplants before modern TPN. Early patients faced technical failure, rejection, and infection.
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Mid-1980s — major advances

Better immunosuppressants (notably tacrolimus) and improved infection control transformed outcomes.
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Today

Hundreds of patients worldwide have transitioned off TPN, resumed oral diets, and improved quality of life.

WHY IT IS CHALLENGING
Unique biology of the bowel
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High immunogenicity

The bowel holds a large amount of lymphoid tissue, creating a strong immune stimulus and higher rejection risk.
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Bacterial load

Immunosuppression that protects the graft also raises the risk of serious infection from the gut’s native bacteria.
The balance: Enough immunosuppression to protect the graft — without leaving the patient defenseless against infection or causing severe drug toxicity.

CLINICAL SUCCESS
Outcomes that matter to patients
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Dietary independence

About 75% of surviving recipients successfully discontinue TPN and return to oral diet.
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Improving survival

Advances in surgery, infection control, and immunology have improved survival; long-term registry data continues to grow.

TYPES OF TRANSPLANTS
Matched to the organs involved
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Isolated intestinal

Small intestine only — for intestinal failure with a healthy, functioning liver.
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Liver–intestine

Liver and small intestine — when intestinal failure is combined with TPN-related end-stage liver disease.
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Multivisceral

Stomach, small intestine, liver, pancreas (sometimes colon/kidneys) — for extensive multi-organ abdominal disease or trauma.
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Modified multivisceral

Stomach, small intestine, pancreas, and duodenum — excludes the liver when the native liver remains healthy.

WHEN TRANSPLANT MAY BE CONSIDERED
Conditions and clinical context
  • Short Bowel Syndrome with irreversible intestinal failure
  • Congenital defects (gastroschisis, intestinal atresia, Hirschsprung’s)
  • Severe motility disorders (pseudo-obstruction, microvillus inclusion disease)
  • Vascular catastrophes (mesenteric thrombosis, volvulus)
  • Infiltrative abdominal tumors or severe localized trauma
Important context: Intestinal transplantation is among the most complex procedures in medicine. Availability is limited, and decisions are made only after thorough evaluation at specialized centers. Discuss medical and non-medical costs with your care team and insurer early.

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Transplant Support
Peer groups & orgs →

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Intestinal Rehabilitation
IRP overview →

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Parenteral Nutrition
PN education →

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Centers of Excellence
IRP directory →