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Intestinal transplantation

  • The Australian Intestinal Transplant Service offers intestinal transplantation to children and adults throughout Australia.  It is a collaboration between The Royal Children’s Hospital Melbourne and Austin Health.  All children are cared for and transplanted at The Royal Children’s Hospital.

    On this page, you will find the following information:

    What is intestinal transplant?

    Intestinal transplant, or short bowel transplant, is an operation to replace a patient’s diseased intestine with a new healthy intestine.  Other organs can be transplanted at the same time if they are also diseased.

    Who needs an intestinal transplant?

    Our intestine provides fluids, electrolytes and nutrients to our body from everything we eat.  Without these things, we cannot grow, and we cannot survive.  When someone has a disease or condition that affects their intestines and the way that they work, this is called ‘intestinal failure’.

    Patients with intestinal failure who cannot nourish themselves by eating, require a special intravenous fluid therapy to provide nutrition, fluids and electrolytes.  This is called ‘parenteral nutrition’ (PN), also known as total parenteral nutrition (TPN).  Parenteral nutrition is given to a patient directly into their blood-stream through a catheter.  Luckily, most patients are very stable on parenteral nutrition.  However, some patients with intestinal failure can have many life-threatening complications of their disease and also from the treatments, such as parenteral nutrition.

    Some of these life-threatening complications are liver disease, severe blood infections, and blood clots in the blood vessels needed to give parenteral nutrition.

    Children with intestinal failure and life-threatening complications of their disease and treatment can be considered for intestinal transplant.

    Who can have an intestinal transplant?

    Eligibility criteria

    To be considered for intestinal transplantation, patients must have: Irreversible intestinal failure and be dependent on parental nutrition PLUS have life-threatening complications of treatment 

    Complications of treatment include:

    • End-stage liver disease, or developing
    • Blood clots (thrombosis) of two or more major veins
    • Two or more episodes per year of severe infection or catheter-related blood stream infection
    • Frequent episodes of severe dehydration even when supplemented with intravenous fluid in addition to parenteral nutrition

    However there are a number of contraindications against intestinal transplant:

    • Potential for intestinal recovery (i.e. intestinal failure is potentially reversible)
    • Cancer that has spread around the body
    • Significant heart or lung conditions
    • Demonstrated patient non-compliance 
    • Ongoing or recurrent infections that are not responding to treatment 
    • Significant psychiatric or social risk
    • Potential complications from immunosuppressive therapy that pose an unacceptable risk to the patient 
    • Total loss of central venous access 
    • Drug dependence considered likely to impair survival

    Formal guidelines for intestinal transplantation in Australia including inclusion and exclusion criteria, organ allocation protocols, and prioritization protocols for combined liver-intestinal transplant recipients, have been established and published in association with The Transplantation Society of Australia and New Zealand.

    Australian patients

    Victorian patients

    Intestinal transplant is currently funded for patients in Victoria by the Victorian government.

    Non-Victorian patients

    Intestinal transplant for patients from all other States and Territories in Australia will need to apply for funding through their Doctor, to their local State/ Territory Government

    International patients

    International patients can discuss with their care providers the option of intestinal transplantation in Australia.

    How can patients be referred for intestinal transplant in Australia?

    Patients should speak to their Gastroenterologist if they are interested in intestinal transplantation.

    For referring clinicians, see following links (please note, if links not working, please email  sue.bates@rch.org.au to request copies of required forms).

    Am I eligible for an intestinal transplant?

    Each patient needs to be thoroughly assessed to see if intestinal transplant is suitable for them, and if they are a suitable candidate for a transplant.  This is based on strict inclusion and exclusion criteria which is defined by the Transplantations Society of Australia and New Zealand.

    Many patients with intestinal failure are very stable on parenteral nutrition, or their intestinal failure and treatments may have possibility for improvement, so intestinal transplant may not be the best option for them.  For other patients, intestinal transplant may be needed now for survival, for example for patients with end-stage liver failure, or may be required at some time in the future.  The transplant team will review each patient and make a decision about the best treatment options.   The transplant team wants to make transplant as safe and successful as possible for each patient.

    What are the alternatives to intestinal transplant?

    The intestine is a very clever organ.  It can continue to change and ‘adapt’ over time.  For many children with intestinal failure, through intestinal rehabilitation services, their intestinal function can improve over many years, and they may in fact be able to come off parenteral nutrition.  Intestinal rehabilitation services include: dietary manipulation, improved fluid and electrolyte and parenteral nutrition support, medication therapies and specialised surgeries.

    For patients who are referred to our service, the transplant team will assess each patient to determine if there are any other options for them, to improve the way that their intestine functions.  The transplant team may also make suggestions to help improve and prevent complications of treatments.

    Clinical Resources

    Outpatient Clinic Review Form, Post-Transplant

    Intestinal transplant protocol (intranet only)