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What Is Small Bowel Transplantation?

Small bowel transplantation is surgery that replaces a permanently failing small intestine with healthy donor intestine, usually from a deceased donor. It is also called isolated intestinal transplantation when the intestine is transplanted without a liver or other abdominal organs. The operation is intended for selected patients with irreversible intestinal failure who cannot be maintained safely with long-term parenteral nutrition. A successful graft can restore intestinal absorption and allow reduction or eventual discontinuation of intravenous nutrition in many recipients.

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What Is Small Bowel Transplantation?

Small bowel transplantation is surgery that replaces a permanently failing small intestine with healthy donor intestine, usually from a deceased donor. It is also called isolated intestinal transplantation when the intestine is transplanted without a liver or other abdominal organs. The operation is intended for selected patients with irreversible intestinal failure who cannot be maintained safely with long-term parenteral nutrition. A successful graft can restore intestinal absorption and allow reduction or eventual discontinuation of intravenous nutrition in many recipients.

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Why Is Small Bowel Transplantation Performed?

The procedure is considered when chronic intestinal failure leads to serious complications despite specialized intestinal rehabilitation and parenteral nutrition. Common reasons for referral include progressive intestinal-failure-associated liver disease, recurrent life-threatening catheter infections, loss of central venous access from thrombosis, or repeated severe dehydration and metabolic complications. Short bowel syndrome remains one of the most common underlying causes of intestinal transplant listing. Patients with irreversible advanced liver failure can require combined liver-intestine transplantation rather than an isolated small-bowel graft.

How Is Small Bowel Transplantation Performed?

The diseased or nonfunctional intestine is removed as needed, and the donor small intestine is placed into the abdomen. The donor mesenteric artery and vein are connected to the recipient's major abdominal blood vessels so the graft receives arterial inflow and venous drainage. The donor intestine is then connected to the recipient's remaining stomach or bowel to restore gastrointestinal continuity. A temporary ileostomy is often created so the transplant team can inspect the graft and perform endoscopic biopsies during early rejection surveillance.

What Is Recovery Like After Small Bowel Transplantation?

Recipients recover in a specialized transplant unit with close monitoring of graft blood flow, bowel function, infection, nutrition, kidney function, and immune rejection. Lifelong immunosuppressive medication is required because intestinal tissue is highly immunogenic and can be rejected rapidly. Enteral feeding is introduced gradually as the graft begins functioning, while parenteral nutrition is reduced according to absorption and nutritional status. Frequent endoscopy and biopsy are used early after transplant because clinical symptoms alone cannot reliably distinguish rejection from infection or other intestinal complications.

What Are the Risks and Complications?

Major complications include acute or chronic rejection, severe infection, graft thrombosis, anastomotic leakage, bowel obstruction, bleeding, and graft failure. Strong immunosuppression increases susceptibility to bacterial, viral, and fungal infections as well as kidney injury and metabolic complications. Post-transplant lymphoproliferative disorder and other malignancies can occur because of prolonged immune suppression. Recurrent intestinal failure, severe rejection, or graft loss can require return to parenteral nutrition, retransplantation, or removal of the transplanted intestine.

Frequently Asked Questions About Small Bowel Transplantation

Who needs a small bowel transplant?

It is considered for selected patients with irreversible intestinal failure who develop serious complications of long-term parenteral nutrition or cannot maintain safe venous access and hydration.

Is small bowel transplantation the same as multivisceral transplantation?

No. An isolated small-bowel transplant replaces the intestine alone, while multivisceral transplantation replaces the intestine together with several other abdominal organs.

Do intestinal transplant recipients need lifelong immunosuppression?

Yes. Lifelong immune-suppressing medication is required to reduce rejection of the donor intestine.

Why are intestinal biopsies performed after transplantation?

Endoscopic biopsy lets the transplant team examine graft tissue directly for rejection because symptoms such as diarrhea or abdominal pain can also be caused by infection or other problems.

References

Endoscopic Surveillance of the Intestinal Allograft: Recommendations From the Intestinal Rehabilitation and Transplant Association Working Group. PubMed. https://pubmed.ncbi.nlm.nih.gov/37723639/. Date Accessed September 11, 2026.

Intestinal and Multivisceral Transplantation: Complications. PubMed. https://pubmed.ncbi.nlm.nih.gov/37495294/. Date Accessed September 11, 2026.

Intestinal transplantation: review of operative techniques. PubMed. https://pubmed.ncbi.nlm.nih.gov/23909503/. Date Accessed September 11, 2026.

New Insights Into the Indications for Intestinal Transplantation: Consensus in the Year 2019. PubMed. https://pubmed.ncbi.nlm.nih.gov/31815899/. Date Accessed September 11, 2026.

The role of endoscopy in the small intestinal transplant recipient: A review. PubMed. https://pubmed.ncbi.nlm.nih.gov/33043624/. Date Accessed September 11, 2026.