Intestine Transplant

What to Expect

You can expect the following prior to your child’s liver transplant operation:

• Your child’s surgeon and transplant nurse coordinator will outline the required medical regimen of daily medicines, frequent lab tests and regular medical visits.
• It is important for you to be fully engaged in your child’s care. The transplant team will watch this closely as it shows how well you can care for your child after the intestine transplant.
• The surgeon will give you instructions on how to keep your child as healthy as possible prior to the transplant. 
• You must optimize your child’s nutrition with guidance from his or her surgeon.
• Your child’s surgeon will provide instructions for physical fitness, including exercise and physical therapy as needed.

You can expect the following on the day of your child’s intestine transplant operation:

• You will need to follow the surgeon's instructions if your child is receiving gastrointestinal tube or parenteral (IV) feedings.
• When you arrive at the hospital, the surgeon will explain the transplant procedure to you and answer any remaining questions. 
• You will be asked to read and sign a consent form for your child’s surgery. Be sure to review this document carefully and ask any questions you may have about the form.
• Your child will change into a hospital gown in a private room. 
Procedural sedation may be used to help your child relax.
• Your child will have an IV line inserted into his or her arm or hand. Additional catheters may be placed in your child’s neck and wrist to monitor heart and blood pressure.
• Just before surgery, an anesthesiologist will administer surgical anesthesia. You may stay with your child until right before he or she is taken into the operating room.
• A tube will be inserted through the mouth and into your child’s lungs to help him or her breath with the help of a ventilator during surgery.
• A catheter will be inserted into the bladder to monitor urine output.
• The anesthesiologist will constantly monitor your child’s heart rate, blood pressure, breathing and blood oxygen level during the surgery.
• The surgical team will sanitize the incision site with an antiseptic solution.
• Your child's surgeon will remove the existing intestine.
• He or she will connect the blood vessels of the patient and donor intestines to begin a blood supply to the new intestine.
• The surgeon will connect the donor intestine to the gastrointestinal tract.
• The surgeon will close the incision and cover the wound with a sterile dressing.

You can expect the following immediately after surgery:

• A nurse will closely monitor your child’s vital signs.
• Pain medicine will be given to keep your child comfortable.
• Immunosuppressive (anti-rejection) medicines are given in large doses at the time of surgery to prevent rejection of the transplanted intestine. 
• Your child will spend a few days in the PICU and will then move to a regular patient floor. How long your child stays in the PICU will depend on how long it takes for the new intestine to start working.
• Your child will be given liquid nutrition to start, typically through parenteral feeding.
• Your child’s surgeon will encourage him or her to sit up, walk and move about in the first few days after surgery.
• Gradually, your child will be able to eat soft foods by mouth followed by a regular diet.
• The transition to a regular diet can take two to three weeks to complete.
• Your child's care team will provide follow-up care instructions prior to discharge, including medicine instructions and proper exercise and nutrition routines. The team will also provide information on how to recognize the symptoms of transplant rejection. It is important that you follow these instructions and contact the doctor if there are any signs of transplant rejection.