Intestinal transplant program

The post-operative period

After the transplant surgery, your child will recover in the pediatric intensive care unit (PICU). He will require frequent laboratory tests as well as intense monitoring of vital signs, urine and stool output, and fluid hydration. Your child will be placed on intravenous nutrition, TPN and intralipids providing the stomach, intestine, and liver with time to recover. Additionally, he will have several IVs, a catheter in the bladder, a tube through the nose into the stomach, and a breathing tube in the mouth attached to the ventilator. The nurses will explain the purpose of all the monitors and tubes during your first visit.

What you should expect during this time:

Approximately one hour after arrival in the PICU, you will be able to visit.
Your child will be on pain medications and strong sedatives to keep him or her comfortable. Additionally, he or she will have several IV's, special tubes in the abdomen (called JP drains), a catheter into the bladder, a tube through the nose into the stomach and a breathing tube in the mouth attached to a ventilator. The PICU nurse will explain the purpose of all monitors and tubes at your first visit.
Your child will return from surgery with an ileostomy, an artificial surgical opening to bring the intestine to the surface of the abdomen, in place. This opening is called a stoma, and stool comes out of this opening rather than traveling through the intestines and out the rectum. A pouch called an ileostomy bag covers the stoma to prevent the stool output from getting on your child's skin and clothes. An ileostomy allows access to the transplanted intestine in order to check for rejection and ensure that the intestine looks healthy. It also allows stool to be measured, which is important since increased stool output can be a sign of rejection and needs to be closely monitored. The ileostomy can usually be removed or “reversed” approximately 6 – 12 months after surgery.
After transplant surgery, your child will also have a gastrostomy feeding tube, or G-tube, in place. This tube is placed from outside the abdomen to the inside of the stomach. Your child's feedings will be delivered through the tube and into the stomach slowly, which helps your child better tolerate feedings. Learn about the home care of the gastrostomy feeding tube here.
Before you see your child, you will be asked to wash your hands because hand washing is the most important way to protect your child from infection after transplant.
The breathing tube will stay in place until your child is stronger and awake enough to breathe independently.
Your child will receive many IV medications while in the PICU. All of these medications will eventually be changed to oral doses when your child begins to eat and drink.
Your child's labs will be checked on a daily basis for the first few weeks after transplantation. Once stable, labs will generally be checked on a biweekly or weekly basis. The laboratory tests are monitored frequently to ensure that your child is receiving the most effective intravenous nutrition, hydration and proper amount of immunosuppressive therapy.
While in the PICU, your child will have a nurse constantly monitoring his or her status. The nurse will encourage you to participate in your child's care as much as possible.
Visiting hours in the PICU are from 10 a.m. to 8:30 p.m. for friends and relatives, but parents and legal guardians may visit 24 hours a day. Due to the large amount of equipment and limited space in the room, we ask that only two people be at the bedside at a time.
Anyone who has been exposed to communicable diseases or who is ill (cold, flu, etc.) is restricted from visiting, and we do not recommend that any child under the age of two years visit the PICU. We suggest that a sibling's first-time visit be coordinated with the bedside nurse to ensure each child is prepared for what he or she will see and hear. This also allows for planning quiet time with the patient during the visit. Due to limited space, we do not allow parents to sleep at the bedside. However, we have a parent/family waiting area where cots are provided.

When the transplant team feels your child is ready, he or she will be transferred to the transplant unit on the 6th floor. At this time:

The staff on the transplant unit and the liver transplant team will prepare your family for discharge, either to your home or to Kohl's House, the hospital's dedicated transplant residence facility nearby.
Your child may go home with a PICC line —an IV designed for long term use, sometimes called a central line — and the nurses on the transplant unit will teach you how to care for this IV at home.

Post-operative procedures

After transplantation, your child's intestine will be examined thoroughly using a procedure called an ileoscopy. During this procedure, a scope is inserted through the ostomy, the intestine is visualized, and small pieces of the intestine will be taken to look for rejection. Since there is not a specific blood test, the only way to detect rejection is evaluating the intestinal cells under a microscope.This procedure will be done weekly for the first month after surgery. Additional ileoscopies will be performed for the following indications: