Small-bowel transplantation

[Mary Mallozziberg]

Small-bowel transplantation is done infrequently (eg, about 81 transplants in the US in 2019). It is being done less frequently because there are new treatments for secondary cholestatic liver disease (eg, Omegaven, nutritional supplements rich in omega fatty acids) and safer total parenteral nutrition line placement techniques.
Small-bowel transplantation is indicated for patients who

Are at risk of death because of intestinal failure secondary to intestinal disorders (eg, gastroschisis, Hirschsprung disease, autoimmune enteritis, congenital enteropathies such as microvillus inclusion disease) or intestinal resection (eg, for mesenteric thromboembolism or extensive Crohn disease)
Develop complications of total parenteral nutrition used to treat intestinal failure (eg, liver failure secondary to cholestatic liver disease, recurrent sepsis, total loss of venous access)
Have locally invasive tumors that cause obstruction, abscesses, fistulas, ischemia, or hemorrhage (usually desmoid tumors associated with familial polyposis)

(See also Overview of Transplantation.)