Summer 2006

Bowel Transplantation

It is not unusual for children and adults with intestinal failure to develop life-threatening complications from administration of total parenteral nutrition (TPN). Severe repeated infections, loss of intravenous access and liver failure can occur with long-term use of this intravenous form of liquid nutrition.

Through the multidisciplinary UCSF Intestinal Rehabilitation and Transplantation Program, small bowel transplantation is offered to carefully selected patients who can no longer tolerate TPN.

A significant percentage of patients who are TPN dependent can be slowly transitioned to oral feedings with the help of a specialized team that includes adult and pediatric gastroenterologists, surgeons, dietitians, nurses, pharmacists and social workers. Treatment options can include specialized nutrition support and bowel lengthening procedures.

As a treatment of last resort, a small bowel transplant may be considered, according to Sang-Mo Kang, M.D., surgical director of the UCSF program. Gastroenterologist Uri Ladabaum, M.D., serves as medical director of the adult component of the program; pediatric gastroenterologist Sue J. Rhee, M.D., oversees the care of children.

Due to advances in immunosuppressive regimens, results of small bowel transplantation have improved over the last 15 years to the point where the procedure is no longer considered experimental, Kang said. However, overall survival is not high because the immunosuppression required to manage graft rejection makes patients prone to infections. After the procedure, patients require months of intensive monitoring to make sure their new bowel is functioning adequately.

Despite these constraints, Kang said bowel transplants can significantly prolong and improve quality of life in carefully selected patients who have not responded to other interventions.

Consultations and Referrals

For more information, please contact the UCSF Intestinal Rehabilitation and Transplantation Program at (877) SM-BOWEL or (877) 762-6935.

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