Multi-Organ Transplant Program

Pediatric Multi-Visceral Transplant

Intestinal failure occurs when the intestines cannot perform their normal functions. When the intestine does not function well, patients become dehydrated and malnourished. Common symptoms of intestinal failure include: persistent diarrhea, muscle wasting, poor growth, frequent infections, weight loss, fatigue, and dehydration.

The most common conditions leading to poor intestinal function include:

• short gut syndrome - Most of the intestine has been surgically removed because of poor circulation, infection, trauma, tumor, or disease.

• poor absorption - Although the entire intestine is present, it is unable to absorb sufficient fluids and nutrients.

• poor motility - The small bowel is unable to contract normally and move food through the intestinal tract.

Treatment for Intestinal Failure

Patients who have severe bowel disease and are unable to absorb nutrition often receive their nutrition from intravenous feedings called "total parenteral nutrition" (TPN). Many patients are maintained on intravenous nutrition for several years. Unfortunately, there are many life-threatening complications from TPN, and some patients eventually develop liver failure as well. When a patient's health continues to worsen on TPN, patients may be referred for intestinal or multi-visceral transplantation.

The Multi-Organ Transplant Program offers a transplant treatment option for pediatric intestinal failure. Intestinal or multi-visceral transplantation is offered to pediatric patients who have severe intestinal failure and a worsening condition despite TPN treatment. For many patients, both the liver and small bowel must be transplanted because TPN has caused severe liver damage. In the case of a large tumor that is "strangling" several of the abdominal organs, it may be necessary to replace the stomach, pancreas, kidneys or other organs along with the liver and intestine. I

The Multi-Visceral Transplant Operation

Small bowel transplant surgery is a complex procedure and may take up to six hours. The operation consists of removing the diseased bowel, transplanting the small bowel, creating an ileostomy, and placing a feeding tube.

Multi-visceral transplant surgery is also complex and may take up to 16 hours to complete. The operation consists of removing the damaged organs and attaching the new organs.

Outcome

According to the international Intestinal Transplant Registry, the results of intestinal and multi-visceral transplantation continue to improve. The majority of survivors are able to stop TPN, eat normally, and enjoy good health. Of all recipients, about two-thirds are children who require either a liver-bowel transplant (35 per cent) or a multi-visceral transplant (23 per cent). Less than half (42 per cent) require only the intestine.

Contact Information

Sandy Williams, Recipient Coordinator