Jejunum Transplantation – Procedure, Care & Outcomes

What is Jejunum Transplantation?

Jejunum transplantation refers to the surgical grafting of the jejunum – the middle section of the small intestine – from a donor to a recipient. It is a specialized form of small intestine transplantation and is indicated when the patient´s own intestine is so severely damaged that adequate nutrient absorption is no longer possible. The procedure is typically performed as part of a broader intestinal or multivisceral transplantation but may also be carried out in isolation or combined with other organs.

Causes and Indications

Jejunum transplantation is considered when conservative treatments and other surgical options have been exhausted. Common indications include:

• Short bowel syndrome: Loss of large portions of the small intestine due to surgery, injury, or disease
• Chronic intestinal pseudo-obstruction: Functional bowel disorder without mechanical blockage
• Crohn disease: Severe inflammatory bowel disease with extensive intestinal involvement
• Radiation enteritis: Intestinal damage following radiation therapy
• Intestinal ischemia: Circulatory disorders causing irreversible tissue damage in the bowel
• Congenital malformations of the small intestine (e.g., gastroschisis, volvulus)

Diagnosis and Pre-Transplant Evaluation

Comprehensive diagnostic workup is performed prior to jejunum transplantation to assess patient suitability:

• Imaging studies (MRI, CT, ultrasound) to evaluate residual bowel and vascular anatomy
• Laboratory tests (renal function, liver enzymes, blood count)
• Assessment of nutritional status and dependence on parenteral nutrition
• Immunological typing (HLA matching) to identify a compatible donor
• Psychosocial evaluation of the patient

Surgical Procedure

Jejunum transplantation is a complex microsurgical procedure performed at a specialized transplant center. The donor organ is harvested, transported under cold storage conditions, and implanted in the recipient. The blood vessels of the graft are connected to those of the recipient (vascular anastomosis), and the intestinal ends are surgically joined (intestinal anastomosis). The operation is performed under general anesthesia and typically lasts several hours.

Postoperative Care and Treatment

Following transplantation, close medical follow-up is essential:

• Immunosuppression: Lifelong use of medications to prevent rejection (e.g., tacrolimus, mycophenolate mofetil, corticosteroids)
• Antibiotic and antiviral prophylaxis: Protection against infections in the immunocompromised state
• Nutritional therapy: Gradual introduction of enteral feeding, initially supplemented by parenteral nutrition
• Endoscopic surveillance: Regular endoscopies for early detection of rejection or complications
• Laboratory monitoring: Regular blood tests to track organ function and drug levels

Risks and Complications

Jejunum transplantation carries specific risks that require close monitoring:

• Rejection: Acute or chronic rejection of the graft by the recipient´s immune system
• Infections: Increased susceptibility to bacterial, viral, and fungal infections due to immunosuppression
• Graft-versus-host disease: Attack of donor immune cells against the recipient
• Graft failure: Loss of function of the transplanted intestinal segment
• Anastomotic complications: Leaks or strictures at the surgical connection sites

Prognosis

Long-term outcomes of jejunum transplantation have improved significantly over recent decades thanks to advances in immunosuppressive therapy and surgical techniques. Many patients achieve long-term enteral autonomy – the ability to meet their full nutritional needs through the gastrointestinal tract. Five-year survival rates range from approximately 50 to 70 percent depending on the transplant center and patient population.

References

1. Abu-Elmagd K. M. et al. - Five hundred intestinal and multivisceral transplantations at a single center. Annals of Surgery, 2009.
2. Intestinal Transplant Association - Standards and Guidelines for Intestinal Transplantation, 2021.
3. World Health Organization (WHO) - Global Observatory on Donation and Transplantation, 2023.