ohutsuolielinsiirrot

Ohutsuolielinsiirrot, or small intestine transplants, are surgical procedures to replace a severely diseased or absent small intestine in patients with intestinal failure who cannot be maintained on adequate nutrition through other means. The aim is to restore nutrient absorption and reduce dependence on long-term parenteral nutrition.

Indications include irreversible intestinal failure with dependence on parenteral nutrition, life-threatening complications from that nutrition such as central-line infections or liver disease, and failure of the remaining bowel to adapt after extensive resection. Conditions causing severe motility disorders or extensive congenital or acquired damage may also lead to consideration of transplantation. Patient selection is individualized and typically involves assessment of organ function, infection risk, and psychosocial factors.

Types of the procedure vary. The main form is an isolated small intestine transplant. In some cases, a multivisceral transplant is performed, which may include the stomach, pancreas, liver, and/or portions of the bowel, often depending on associated diseases or liver conditions from long-standing parenteral nutrition. In multivisceral transplants, the liver component can reduce certain immune-related complications.

Donor and recipient matching consider blood type, size, and immunological compatibility. Immunosuppression is required for life and typically includes induction therapy at transplant and ongoing maintenance with agents such as calcineurin inhibitors, antimetabolites, and steroids, with adjustments based on rejection risk and infection. Complications include rejection, infection, and, in some cases, post-transplant lymphoproliferative disorders; there is also a risk of graft-versus-host disease, particularly with some intestinal-containing procedures.

Outcomes have improved with advances in surgical technique and immunosuppression, but small intestine transplantation remains complex and is performed in specialized centers. Long-term success depends on careful selection, postoperative management, and adherence to follow-up care.