Yes, the large intestine can be transplanted, though it is almost never transplanted on its own. In practice, the colon is included as part of a broader intestinal transplant, grafted alongside the small intestine or as one organ in a multi-organ package. Intestinal transplantation remains one of the rarest and most complex solid organ transplants performed today, with only about 135 new patients added to the U.S. intestine waiting list in 2023.
Why the Colon Is Rarely Transplanted Alone
The three main types of intestinal transplant currently performed are isolated small bowel, combined liver-intestine, and multivisceral (which includes the stomach and other organs). When surgeons refer to an “isolated intestine transplant,” they typically mean a graft of the jejunum and ileum (the two longest sections of the small intestine), with or without a segment of colon attached. The colon is included when the patient’s condition requires it, but it is not transplanted in isolation.
The reason is straightforward: transplants are driven by intestinal failure, and intestinal failure is overwhelmingly a problem of the small bowel. The small intestine handles the vast majority of nutrient and fluid absorption. When it fails, patients become dependent on intravenous nutrition to survive. The large intestine’s primary job, absorbing water and forming stool, can often be managed through other means if the small bowel is functioning. So the clinical need for a standalone colon transplant is extremely limited.
When the Colon Is Included in a Transplant
There are specific conditions where transplanting the colon alongside the small intestine becomes necessary. One well-documented example is total intestinal aganglionosis, a severe form of Hirschsprung disease where nerve cells are missing throughout the entire intestine. These patients cannot move food through their digestive tract at all. A study of 12 children with this condition found that intestinal transplantation with colon grafting was the preferred treatment, as it was the only realistic path to getting them off intravenous nutrition permanently.
Other conditions that may call for colon inclusion are extensive motility disorders affecting the entire gut, such as chronic intestinal pseudo-obstruction (where the bowel behaves as if blocked even when it isn’t) and microvillus inclusion disease. In multivisceral transplants, the graft can include the stomach, duodenum, pancreas, liver, small intestine, and colon, essentially replacing most of the digestive system. According to 2025 registry data, full multivisceral transplants account for about 19% of pediatric intestinal grafts, with isolated intestine transplants making up 29% and combined liver-intestine grafts at 38%.
The Immunological Problem
Intestinal transplants carry the highest rejection rate of any solid organ transplant, exceeding 40%. The gut is packed with lymphoid tissue, including lymph nodes, immune cell clusters in the intestinal lining, and structures called Peyer’s patches. This dense concentration of immune cells makes the transplanted organ highly reactive in both directions: the recipient’s immune system attacks the graft, and immune cells within the graft can attack the recipient’s body.
This two-way immune battle is what makes intestinal transplants so challenging. Within 24 hours of surgery, the recipient’s immune cells begin infiltrating the graft’s lymph nodes and immune structures. By days three to five, more than half of the immune cell population in the graft’s drainage system has turned over to recipient-derived cells, which then expand and trigger inflammatory responses. If the recipient’s immune response overwhelms the graft, rejection occurs. If the graft’s immune cells overpower the recipient, a condition called graft-versus-host disease develops.
Adding the colon to a transplant increases this immunological burden because it introduces even more lymphoid tissue. The colon contains a vast and diverse microbial population, which further stimulates immune activity. This is another reason surgeons include the colon only when it is clinically necessary.
How the Surgery Works
Connecting a transplanted intestine to the recipient’s blood supply requires precise vascular surgery. The donor organ’s artery is typically joined to the recipient’s abdominal aorta, while the vein draining the graft can be connected either to the main abdominal vein (systemic drainage) or to the portal vein that feeds the liver (portal drainage). Portal drainage more closely mimics natural anatomy, since blood from the gut normally passes through the liver before reaching the rest of the body.
When a living donor provides a segment of intestine, the process uses the ileocolic artery and vein, connecting them to the recipient’s aorta and main abdominal vein respectively. For combined bowel-liver transplants, the surgery becomes significantly more complex, requiring multiple vascular connections including a separate portal vein anastomosis and sometimes removal of the recipient’s portion of the main abdominal vein.
Survival Rates and Long-Term Outlook
Short-term outcomes for intestinal transplants have improved substantially. For transplants performed in 2019, only 3.3% of grafts had failed by six months and 6.7% by one year. The longer-term picture is less encouraging: graft failure at three years remains around 40%, and by five years it reaches roughly 50%.
Patient survival tells a slightly better story, since patients can sometimes return to intravenous nutrition if the graft fails. One-year patient survival for isolated intestine transplants performed between 2013 and 2015 was 83.7%. By five years, survival settled at 58.7%, identical to the rate for patients who received a combined intestine-liver transplant. Children tend to fare better than adults, with five-year graft survival reaching 61.3% for recipients under 18, compared to 44.8% for adults.
Recovery and Diet After Transplant
The entire goal of intestinal transplantation is to free patients from dependence on intravenous nutrition, allowing them to eat and absorb nutrients on their own. In the early recovery period, patients typically follow a high-protein, low-fat diet supplemented with medium-chain triglycerides, a type of fat that is easier for a recovering gut to absorb. This restrictive diet is temporary, though it needs to be carefully managed because staying on it too long can lead to essential fatty acid deficiency.
Oral rehydration solutions and medications that slow gut motility help reduce fluid losses, which can be significant in the early months as the transplanted intestine adapts. Over time, the goal is for patients to transition to an unrestricted diet that meets their nutritional, fluid, and electrolyte needs without supplements or intravenous support. How quickly this happens varies widely depending on the extent of the transplant, whether the colon was included (which improves water absorption), and how well the graft functions without episodes of rejection.
Bioengineered Intestine Research
Researchers are working on an alternative approach: growing functional intestinal tissue in the lab. One team has successfully created small intestinal grafts by stripping donor intestinal tissue of its cells, leaving behind a scaffold of structural proteins with intact blood vessel pathways and the finger-like projections that line the gut wall. They then repopulated this scaffold with human stem cell-derived intestinal cells and endothelial cells to rebuild the lining and blood vessels.
These bioengineered grafts have demonstrated basic absorptive function in laboratory testing and survived long-term implantation in animal models. However, they currently lack a functional nervous system, which is essential for the coordinated muscle contractions that move food through the gut. The technology is not yet mature enough to replace native intestine, but researchers envision initially using small bioengineered segments to add absorptive surface area for patients with short bowel syndrome. Scaling this approach to human-sized organs, improving cell maturation, and engineering functional blood vessel networks all remain significant hurdles.