Your Transplant

Initial Assessment

Patients who have been referred to our Intestinal Rehabilitation and Transplantation Program must complete an evaluation process before qualifying for the program. Our team reviews each person's complete medical history, including their primary diagnosis, previous surgeries, previous treatments and current nutritional status to determine whether they will benefit from intestinal rehabilitation.

The patient evaluation process includes:

* Consultations with a gastroenterologist and nurse practitioner, surgeon, nutritionist and social worker
* Laboratory tests
* Radiological tests
* Additional tests when necessary, such as endoscopy with biopsy, gastrointestinal motility testing, breath hydrogen testing for bacterial overgrowth or malabsorption and imaging tests, such as abdominal CT scan

After the evaluation process is completed, our team determines if you should be admitted into the Intestinal Rehabilitation Program. If you are admitted, a comprehensive, individual treatment plan is designed to best meet your needs.

Transplant Selection Committee

Once the evaluation process is complete and the patient meets the minimal listing criteria, the patient's case is presented to a multidisciplinary selection committee, which includes the following health care professionals:

* Transplant surgeons
* Transplant coordinators
* Dietitians
* Social workers
* Gastroenterologists

All issues related to your case are presented and addressed to determine if you are an appropriate candidate for a transplant at Northwestern. The committee discusses whether they believe you would benefit more with or without a transplant. They will also discuss whether an isolated intestine transplant or multivisceral transplant is indicated. Once it is determined that you are an appropriate transplant candidate, your medical records must then be submitted to your insurance company requesting financial approval for transplant. When this approval is obtained, your name will be placed on the UNOS (United Network for Organ Sharing) national waiting list.

If you are not seen as an appropriate candidate for transplant, the committee may recommend further investigation of a particular medical or psychosocial issue. Your case could then be re-presented to the selection committee at a later time. Patients who do not meet the qualifications for transplantation may be followed by a specialist for medical treatment or returned to the care of their referring physician.

When one of our transplant surgeons is notified of suitable donor organs, the Northwestern transplant team travels to the donor hospital for the organ procurement. The Northwestern transplant surgeon removes the needed organs and places them in a special cold solution for temporary preservation. The team quickly returns to Northwestern, where another transplant surgeon has prepared the recipient in the operating room for the new organ(s).

Upon notification that donor organs have become available, the transplant coordinator will call and request that you immediately come to the hospital in preparation for surgery. Once in the operating room, you will receive the first doses of intravenous immunosuppressive medicines to prevent organ rejection.

The intestine/multivisceral transplant surgery generally lasts from eight to 15 hours, depending on which organs are being transplanted and other factors.

The average length of stay in the hospital after your transplant is 8 days, but you will need to remain in the Chicago area for approcimatley 3 months.

Surgical Options

Surgical options include a number of methods to taper the intestine in hopes of improving intestinal motility and preventing the development of bacterial overgrowth. Additionally, a number of other surgical methods to lengthen the intestine have also been introduced. These include the Bianchi method and the more recent STEP procedure. All of these options may be considered in patients with SBS, however, they are used only after it is clear that medical management is not effective in weaning the patient off TPN.

A surgeon is available for consultation at the clinic and will make recommendations specific to the individual need and clinical presentation. Surgical procedures performed at Northwestern Memorial Hospital include bowel lengthening either by a standard Bianchi or STEP procedure and bowel tapering. Additionally, routine gastrointestinal surgeries, including feeding tube placement and management, and antireflux procedures are provided.

After Surgery

Most of your tubes and IVs will be removed within a few days after surgery with the exception of the enteral feeding tube, which will still remain in your small bowel after you return home.

After surgery, your activity will gradually increase from sitting on the side of the bed, to getting up in a chair, to walking short distances. After the immediate postoperative period has passed, the patient and family learn about the importance of the immunosuppressive regimen, and a daily home medication routine is established. Our staff will provide information concerning how to identify the signs and symptoms of infection or rejection and the appropriate steps to take.

Many transplant recipients experience rejection at some point after transplant. Rejection is classified as mild, moderate or severe, and its treatment generally requires hospitalization.

Preparing for Discharge

Once good organ function has been consistently demonstrated, the immunosuppressant regimen has been established and there is no sign of rejection, you will be prepared to go home. Hospitalization for intestine transplantation generally ranges from three to eight weeks. It is critical that you are knowledgeable and responsible about your medication regimen.

While on the transplant unit, you will learn the following:

1. How to monitor your blood pressure, pulse and weight
2. How to care for your incision and ostomy
3. Name, purpose and common side effects of your medications
4. Signs and symptoms of rejection and infection
5. When to call your coordinator.

Please feel free to ask questions during this time of learning. You will be given a brief discharge test that you must pass before being allowed to go home. This test measures your knowledge of the information the transplant team feels is critical that you know before you leave the hospital.

Before leaving the hospital, you will be given prescriptions for your new medications. You may have these filled at the outpatient pharmacy located in the hospital or at the pharmacy of your choice. The social worker can assist you in making the best choice based on insurance benefits and restrictions.

A clinical transplant coordinator will schedule a teaching session with you and your family before you go home. He or she will discuss your daily routine at home, review the signs of rejection and infection and any limitations you may have. The coordinator will explain the outpatient transplant clinic routine and the schedule for biopsies and scopes. The transplant coordinator will assess your knowledge of medicines and will answer any questions you have.

Patients return to the transplant clinic at least once a week during the first month after transplant. A coordinator will be available to talk to you about any concerns you may have between these scheduled appointments.