Transplantation is at the forefront of cutting-edge surgery and medical sciences. While kidney, liver, heart, and lung transplants are widely recognized as life-saving procedures, breakthroughs in intestine transplants are emerging as a viable option for patients with intestinal failure. The first successful intestine transplant was performed by the pioneering surgeon Dr. John Najarian at the University of Minnesota in the United States in 1959. A young boy developed short bowel syndrome after he had to undergo removal of most of his intestines due to gangrene. He was unable to absorb nutrients and fluids properly, affecting his growth. With the intestine transplant, he was well. The first successful intestine transplant in India was performed by the author with his senior colleagues and team at Medanta, Gurugram in 2012 and reported in a scientific journal as a co-author. The field has grown slowly over the years and currently, about 200 intestine transplants are performed every year globally and about 5 cases in India annually.

An intestinal transplant is a surgical procedure in which the intestine is transplanted in patients with severe intestinal dysfunction or failure. Intestinal failure may be due to damage to the intestine due to gangrene (necrosis of the intestine due to blockage in blood supply) or very large tumors requiring surgical removal of most of the intestine. Generally, the small intestine is about 25 feet long in adults and even 1 – 2 feet of it remains after such a major surgery, it naturally adapts and absorbs sufficient nutrition.

Patients with intestinal failure have a significant risk to their lives and may require nutritional supplements to be given intravenously (IV). IV nutrition is not only very expensive in the long term it is also associated with the risk of recurrent infections in the IV lines. While the small intestine absorbs most nutrients, the large intestine absorbs more fluids. Some centers only transplant the small intestine during the transplant, while others transplant both the small and large intestine, with similar results for both. Long-term IV nutrition may also cause liver failure, in which case, patients may require a combined liver and intestine transplant.

In some cases, although the intestine may be normal in length, it may not be able to absorb nutrients and fluids efficiently or have sub-optimal motility, leading to nutritional failure. In such cases, if the motility disorder involves the stomach and large intestine too. A combined transplant of the stomach intestine and liver is called a multi-visceral transplant. The pancreas is almost always also a part of the multi-visceral organ cluster, as it is difficult and risky to separate from the duodenum (early part of the small intestine). A multi-visceral transplant without the liver is called a modified multi-visceral transplant.