Intestinal Transplants in Crohn’s Patients with Short Bowel Syndrome

Intestinal Transplants in Crohn’s Patients with Short Bowel Syndrome
In last week's column, I discussed the autoimmune disease that caused my liver to fail. As I celebrated the second anniversary of my liver transplant, I thought about intestinal transplants and the inflammatory bowel disease community. The Scientific Registry of Transplant Recipients lists 27 intestine transplant centers in the United States. Based on statistics from the United Network for Organ Sharing, surgeons performed 104 intestine transplants in 2018, with 53 patients receiving transplants this year as of Aug. 31. One of the primary reasons for an intestine transplant is short bowel syndrome (SBS), which can occur in Crohn’s patients who undergo a bowel resection to remove damaged portions. As most nutrients are absorbed through the small intestine, patients with SBS must modify their diet or take nutritional supplements. In severe cases, patients receive a nutritional formula intravenously via total parenteral nutrition (TPN). In an interview with the journal Gastroenterology & Hepatology in 2012, gastroenterologist Dr. Suki Subramanian noted that Crohn’s disease is the “second leading indication for intestinal transplantation worldwide.” She said that transplantation for Crohn’s patients should be considered in those with SBS when TPN is failing due to complications. Those who experience recurring catheter-related sepsis should be evaluated. Liver dysfunction, such as cholestasis or cirrhosis, may also indicate TPN failure. According to the Organ Procurement and Transplantation Network (OPTN), the entire intestine or a segment can be transplanted. The operation is often performed in conjunction with a liver transplant. While most organ donations come from deceased donors, a living donation of an intestinal segment is possible. Bec
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