Intestinal Transplant in Children
Small Bowel Transplant for Intestinal Failure
An intestinal transplant can be a life-saving option for your child with intestinal failure. Duke is among a handful of U.S. hospitals with experienced transplant surgeons who perform intestinal transplants on children when disease prevents nutrients from being absorbed by the body. Our team will help your child through every step of this journey, from managing the condition before the transplant, through recovery and follow-up.
Treatment Options for Children with Intestinal Failure
Duke has a long history of caring for children with gastrointestinal (GI) conditions including short bowel syndrome, congenital intestinal disorders of malabsorption, trauma, dysmotility disorders including pseudo-obstruction, and small bowel tumors, all of which can lead to intestinal failure.
Intestinal failure may be medically treated with intestinal rehabilitation, which can restore your child’s ability to absorb nutrients and may delay or potentially eliminate the need for a small bowel transplant. This medical treatment usually includes a combination of Total Parental Nutrition (TPN), which delivers nutrition intravenously through a catheter, and enteral feedings with special formula through a tube going directly into the intestine or stomach.
Choosing Duke for Your Child's Intestinal Transplant
If an intestinal transplant -- also known as a small bowel transplant -- is recommended, you can feel confident choosing Duke for your care.
- Our transplant surgeons have performed hundreds of these complex procedures. In addition to intestinal transplants, we also perform multi-organ transplants that include the small intestine, large intestine, liver, pancreas, and/or kidney.
- Our outcomes exceed the national average. According to the Scientific Registry for Transplant Recipients, 75 percent of our patients are alive with a functioning transplant one year after surgery, compared to a national average of 65 to 70 percent.
- We successfully treat children who have been declined for an intestinal transplant at other hospitals.
Our Team Approach to Pediatric Intestinal Transplant
- The Duke intestinal transplant program is led by experts in hepatology (care of the liver, gallbladder, biliary tree, and pancreas) and transplant medicine and surgery, some of whom hold leadership positions in national transplant organizations such as the Intestinal Rehabilitation and Transplant Association and the United Network for Organ Sharing (UNOS).
- Our doctors and surgeons test new techniques and therapies and help set national guidelines. They also develop educational materials that are used when intestinal transplants are performed internationally.
- Your child may be able to participate in clinical trials that test new therapies designed to improve nutrient absorption in people with intestinal failure, as well as ways to reduce transplant rejection.
- Our team includes transplant coordinators, dietitian, and social worker, who help you navigate the process. These advanced-care nurses and our team members can answer questions you may have about the wait time before the small bowel transplant, the surgery, physical and emotional issues, dietary requirements, and more.
- For urgent matters, an intestinal transplant coordinator is on-call 24 hours a day, 365 days a year. Additionally, an intestinal transplant doctor is on-call at all times for any urgent concerns that arise.
INTESTINAL TRANSPLANTS IN CHILDREN
The Intestinal Transplant Process
The first step is an extensive evaluation with all members of the team to determine whether intestinal transplantation is the appropriate therapy for your child. The process may include various tests and screenings such as blood tests, abdominal imaging, and special procedures (ie endoscopy and/or liver biopsy) depending your child’s individual needs. Our transplant coordinator will help you plan this evaluation.
If the evaluation shows that intestinal transplantation is appropriate for your child, your child will be listed in the national database maintained and administered by the United Network for Organ Sharing (UNOS). The average wait time is three to 12 months. Once you receive notification that an organ is available, your child will need to arrive at Duke within six hours.
You will participate in transplant education to learn more about the process and expectations, the medications your child will need, and how to address your child’s physical and emotional needs before and after transplant. A primary and secondary caregiver will participate in more intensive education after the transplant but prior to discharge from the hospital.
Following the intestinal transplant, doctors will closely monitor your child's response to the surgery. We will prescribe and manage medications to prevent rejection. In addition, we perform routine small-bowel biopsies to monitor the transplanted graft. The length of time patients spend in the hospital post-transplant can vary from several weeks to several months. Your child will need to stay in the Durham area for an additional 1-3 months or possibly longer for follow-up care before returning home.