Bowel transplant - Risks of a small bowel transplant

As with all types of surgery, there are risks associated with having a small bowel transplant.

Better anti-rejection drugs, refined surgical procedures and a greater understanding of the body's immune system have increased the number of successful bowel transplants and improved survival rates in recent years.

However, potentially serious complications can still occur, such as:

• heart and breathing problems
• infection of the small bowel ‐ such as an infection by the cytomegalovirus (CMV)
• blood clots (thrombosis)
• post-transplant lymphoproliferative disorder (PTLD) ‐ where the Epstein-Barr virus infects white blood cells, which can lead to abnormal growths throughout the body and multiple organ failure, if not promptly treated
• rejection of the donor organ (see below)
• problems associated with the long-term use of anti-rejection medication ‐ such as an increased risk of infections, kidney problems and certain types of cancer

Due to these risks and the overall poor health of people who are considered for a small bowel transplant, some people will die within a few years of the procedure. However, the majority of adults and children who have the operation will live for at least another five years.

What is rejection?

Rejection is a normal reaction of the body. When a new organ is transplanted, your body’s immune system sees it as a threat and makes antibodies, which can stop it from working properly.

This is also known as graft versus host disease (GvHD), and it can occur within a few weeks of a transplant or, less commonly, a few months or even years later.

Immunosuppressant medications that weaken your immune system are given during and after your transplant and must be taken for life, to reduce the risk of your body rejecting your new bowel.

As well as stopping the donated organ working properly, rejection can sometimes mean that bacteria found in the small bowel can get into your bloodstream and cause a serious widespread infection. You will be closely monitored by the transplant team after surgery to reduce this risk.

In some cases where the transplant fails, you may be put on the waiting list again for another transplant.