Recovery at the transplant centre

After a bowel transplant you will be transferred from theatre to the intensive care unit (ICU). You will be kept asleep initially. ICU care is an essential part of the post-operative recovery and the length of your ICU stay will vary according to how sick you were going into the transplant and how well your body copes with the new organ(s).

Over the next few days, as you require less nursing support and monitoring, you will move to the high dependency unit, and then to the main transplant ward.

Critical care doctors and nursing staff care for you in the intensive care unit (ICU). There is always a nurse at your bedside. The transplant team will also be involved with your care while you’re in the ICU.

The nurses and doctors looking after you will keep a close eye on your pulse, blood pressure, temperature and urine output. You will need regular blood tests, as least once daily and usually more often.

You will feel sore after the surgery. Pain is initially controlled by strong painkilling drugs delivered continuously via a drip (for example, morphine).

This then changes to tablet painkillers as you recover.

Pain control is important to help you breathe deeply and cough, and to allow you to move freely.

• There are specialist pain teams that can help you if your pain is not well controlled.
• It is important that your pain is well controlled. This will help you get out of bed earlier, and reduce the risk of blood clots in the legs and lungs. Good pain control will help you take deep breaths and reduce the risks of developing a chest infection. However, painkillers have side effects, including sickness, itching, drowsiness, and constipation.

Specialised equipment is used to monitor your recovery and give you essential fluid and drugs. When you wake up in intensive care, your tubes and drips are still in place.

You will continue on intravenous feeding (parenteral nutrition) until your bowel transplant functions adequately.

Sometimes when you wake from the surgery, you will still be attached to a ventilator, which is a machine that helps you breathe. This breathing tube is removed after you wake up and are able to breathe on your own.

When the tube is removed you can speak again although you will need oxygen via a mask or tubing. You may have a sore throat and a hoarse voice. A physiotherapist will help you with breathing exercises and coughing, which are important to prevent breathing problems or chest infections.

Some patients with bowel disease also have problems with their kidneys, which may improve after a transplant. However, some patients who have very complex surgery may need to be placed on a dialysis machine until their kidney function recovers.

If you have had a kidney transplanted along with your bowel, you might need to continue on dialysis until your kidney transplant starts to function adequately.

The physiotherapist will work with you to ensure that your lungs are working well and you are breathing fully. They will also help you with getting out of bed and getting strength to walk after your surgery.

Rejection is common after a bowel transplant. The best way to pick up rejection is to do regular biopsies of the bowel using a telescope test (endoscope).

You may need regular biopsies in the first few weeks after a bowel transplant so that any rejection can be picked up early and treated.

> Learn about bowel rejection

Many medicines will be prescribed after a bowel transplant, for example to prevent rejection or infection, or to manage pain or blood clotting.

All patients that have a transplant will need immunosuppressants. These lower the function of your immune system and reduce the chance of your body rejecting your new bowel.

Each transplant centre unit uses slightly different medicine doses and types. Before you leave the transplant centre, you will be given detailed information about your medicines and how to take them. You’ll also be told what other medicines or food to avoid.

It’s very important that you take all your new medicines as directed.

> Learn more about transplant medicines

In time, it is expected that your new bowel will start to function and absorb food and fluid.

Once the bowel transplant is functioning adequately, the amount of intravenous feeding (parenteral nutrition) will reduce and eventually stop.

You will be told what food and fluids to avoid.

The physiotherapist will work with you to ensure you are mobile and safe to go home, and if you have stairs at home that you are able to climb these.

You will only be discharged from hospital when:

• You are physically strong enough
• Your immunosuppressant medication levels are adequate
• You have learnt enough about your condition to look after yourself at home. This will include information about your medications, knowing how to look for symptoms of rejection or infection, and information about any lifestyle changes you need to make.

If you start taking any over-the-counter medications you should discuss this with your GP or transplant team first as they may affect your immunosuppressant medications. You should not take any herbal medications without speaking to your transplant team first.

Some patients are discharged home with intravenous fluid support to protect their kidneys. This is expected to be temporary.

Depending on how well your bowel transplant is functioning, you’ll be given information on what foods and liquids to avoid. You may need to take nutritional drinks to support your nourishment.

If you require extra support at home (for example, help with cooking, cleaning, mobility, wound care), this will be discussed with you before you leave hospital.

To start with, most patients will be seen at least once a week in the transplant clinic after their operation. For many patients this might be by phone or video call.