Pre Transplant

Before undergoing transplant, you may need to undergo rigorous evaluation, which includes:

General health exam

This consists of a physical examination and cancer screening tests to evaluate your overall health.

Blood tests

There are different blood tests that you may need to undergo to know about gene compatibility.

Imaging tests

Various tests like CT scan, MRI, or PET scan may be recommended to look for any abnormality in the organs.

Social and psychological evaluation

These evaluations are done to assess your overall stress, financial issues, and support by your friends and family.

Ultrasound

Ultrasound is done with the help of sound waves creates a picture of the internal organs, and it gives the inside picture of the organ. Endorectal ultrasounds are commonly performed to find in case of cancer and how deeply rectal cancer has grown. It also helps plan treatment.

Colonoscopy

Colonoscopy helps the doctor to look inside the entire colon for any abnormality. In this procedure, a long, flexible tube (colonoscope) is inserted into the rectum. There is a tiny video camera at the tip of the tube that gives the pictures.

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Pre- Intestinal Transplant evaluation

Before undergoing transplant, you may need to undergo rigorous evaluation, which includes:

General health exam

This consists of a physical examination and cancer screening tests to evaluate your overall health.

Blood tests

There are different blood tests that you may need to undergo to know about gene compatibility.

Imaging tests

Various tests like CT scan, MRI, or PET scan may be recommended to look for any abnormality in the organs.

Social and psychological evaluation

These evaluations are done to assess your overall stress, financial issues, and support by your friends and family.

Ultrasound

Ultrasound is done with the help of sound waves creates a picture of the internal organs, and it gives the inside picture of the organ. Endorectal ultrasounds are commonly performed to find in case of cancer and how deeply rectal cancer has grown. It also helps plan treatment.

Colonoscopy

Colonoscopy helps the doctor to look inside the entire colon for any abnormality. In this procedure, a long, flexible tube (colonoscope) is inserted into the rectum. There is a tiny video camera at the tip of the tube that gives the pictures.

Waiting Period

There are more patients in need of an intestinal transplant than the bowel donated. Hence, the waiting list is long in India. While being on the waiting list for organ, your doctor will start the other treatment and plan a treatment that will keep you in stable condition and prepare you for your upcoming transplant procedure. Keep your doctor informed about any changes your experience about your health and get a consultation.

The Intestinal Transplant process

Urgent call
In case the hospital where you have registered for your transplant received the organ, they will immediately call you and admit you.

Evaluation
After you are admitted, you will undergo various tests and evaluations to assess if you are healthy enough to undergo transplant surgery.

Anesthesia
Once you are cleared by your doctor for surgery. You will be taken to the operation theatre, and anesthesia will be given to numb the pain.

Ventilator
Depending upon the health condition, some patient's may need ventilator support.

Incision
Your doctor will make an incision in the abdomen to have access to your intestine.

Abdomen evaluation
An evaluation will be done to look for abnormalities in the intestine and other organs around it.

Removal of the intestine
At this step, your intestine will be removed (together with other organs in case of a multi-visceral transplant), and the appropriate donated organ(s) will be placed into the abdomen.

Stoma
A stoma is an opening surgically-created in the small bowel or colon (respectively ileostomy and colostomy), which allows the transplant team to monitor the transplanted organ. After some time, usually 6 to 12, the stoma will be closed.

Gastrojejunostomy feeding tube
In some cases, gastrojejunostomy tube inserted during the operation through the skin and into the GI tract. One end is in the stomach. It is usually used to decompress the stomach or to administer medications. This tube is usually removed after and reasonable nutritional independence is achieved. In some cases, this tube is not placed.

Closure
After the procedure is complete, an incision is closed.

Complications of Intestinal Transplant

  • Surgical Complications: Certain complications may occur during or shortly after the surgery, such as:
  • Wound infection
  • Blood clot in the artery or vein of the lungs, heart, spleen, pancreas, or liver.
  • Diabetes
  • Bile leakage from the bile ducts
  • Uncontrollable bleeding
  • Infection: You will be prescribed immunosuppressants to suppress the action of the immune system to aid the adjustment of the new organ in the body. However, taking immunosuppressants may expose you to various infectious diseases.
  • Rejection: Sometimes, your new organ may not be accepted by the body and hence may not be able to function appropriately. Our immune system recognizes the foreign organisms or particles such as viruses or bacteria, and it might not accept the new organ as well, leading to chances of rejection.
  • Anti-rejection medications side effects: You will be prescribed various anti-rejection medications for the proper functioning of the liver and overall health. These medicines can behave certain major side effects such as:
  • Weight gain
  • High blood pressure
  • Damage to kidneys
  • Cholesterol imbalance
  • Thrombosis: It is the clot that forms in the artery or vein of the new intestine. It leads to the stoppage of the blood supply to the intestine.
  • Bleeding: There is a high risk of internal bleeding linked with major surgeries. This may call for blood transfusion, and another surgery may be required to stop the bleeding.
  • Leak: Sometimes, the leak may occur at a point where your new intestine has been attached to your own organ. You may need to undergo an operation to stop this leak.

Laboratory evaluation

  • Blood group (ABO): To know the blood group for a compatible donor
  • CBC: To find out the degree of anemia and its treatment before transplant
  • Urine routine and culture: To rule out urinary tract infection and check the degree of proteinuria pre-transplant.
  • Liver function To detect liver impairment
  • Blood glucose: To rule out diabetes and check sugar control in diabetics
  • Lipid profile: To detect abnormalities and treat.
  • Renal function tests: Preoperative electrolytes for fitness.
  • PT/PTT/BT: To rule out bleeding and coagulation abnormalities
  • HbsAg/HCV/HIV/EBV/CMV IgG: To detect these viral diseases and treat them. Some of these viral diseases may get activated, or CMV may require prophylaxis after transplant.
  • Tissue typing/HLA: To determine compatibility with donor relationship with the recipient.
  • Lymphocyte cross-match: To detect any antibody against donor T cell and B cell in the blood of the recipient (compatibility of donor and recipient and chances of rejecting organ)
  • Uroflowmetry post-void residue: To find out obstruction and bladder status before transplant.
  • CT scan plain/iliofemoral vessel doppler: To detect kidney stones or calcification in your iliac blood vessels where donor kidney vessels will be joined.
  • Gastrointestinal endoscopy: Selected patients showing stool occult blood positive or past history of peptic ulcer may require gastrointestinal endoscopy.

Donor evaluation:

If a donor is available, preferably an 18 to 65 years of age pre-emptive transplant before going on to long-term dialysis may be considered. Pre-emptive transplant is cost-saving and has better outcomes. You as a donor will be evaluated, and short and long-term risks will be discussed as per the donor's health profile.

ABO compatibility will be tested nowadays because of advances in technology, and immunosuppression medication transplants can be done across the ABO barrier. The cost will be higher, and the risk will also be higher.

There is also an option of paired or swap kidney transplant.

compatibility and cross-match testing will be done to assess your immunological risk and is mandatory by HOTA (Human Organ and Tissue transplant Act.)

Medical evaluation:

The purpose of medical evaluation of a donor is to determine that you are in good health, don’t have any renal problems, diabetes, hypertension, psychologically sound, no disease that can be transmitted to the recipient. It will be confirmed that you don’t have long term or short-term risk for removing one kidney. You will undergo the following investigations as a donor.

  • Cardiac evaluation: ECG, 2D echocardiography, and cardiac stress test.
  • Pulmonary evaluation: X-ray Chest, ABG (arterial blood gases) &Lung function tests.

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