A stomach transplant, as a single organ replacement, is extremely rare in modern medicine. The stomach is almost never transplanted by itself because alternative surgical options, such as a total gastrectomy connecting the esophagus directly to the small intestine, are life-sustaining. When the stomach is replaced, it is nearly always performed as part of a multi-visceral transplant (MVTx). This complex operation involves replacing multiple organs of the abdominal digestive system simultaneously due to widespread disease or failure.
Solitary Stomach Transplant vs. Multi-Visceral Procedures
A solitary stomach transplant is not standard practice due to the organ’s function and anatomical proximity to other digestive organs. The stomach primarily mixes food and begins digestion, a function the small intestine can compensate for after surgical removal. Furthermore, the stomach shares a common blood supply with the small intestine, pancreas, and liver, making it surgically impractical to isolate.
A multi-visceral transplant is a sophisticated procedure involving the en bloc replacement of an organ cluster from a single donor. The full MVTx typically includes the stomach, duodenum, pancreas, and small intestine, often along with the liver. This combined approach is necessary because the diseases affecting the stomach usually impact the entire gastrointestinal tract and its supporting vasculature.
The stomach’s inclusion is usually secondary, driven by the need to replace the small intestine, the most important organ in the cluster. The small intestine absorbs nutrients, and its failure necessitates replacement. If small intestine failure is accompanied by disease in the adjacent stomach, the entire group of organs is transplanted together to simplify blood vessel connections.
Medical Conditions Requiring Stomach Replacement
Conditions requiring MVTx involving the stomach are severe, irreversible, and have failed all other medical and surgical treatments. A major indication is irreversible intestinal failure, often from short bowel syndrome, where extensive loss of the small intestine prevents nutrient absorption. This intestinal failure is often accompanied by liver damage caused by long-term total parenteral nutrition (TPN), requiring replacement of both the small bowel and the liver.
Other indications involve extensive abdominal pathology, such as diffuse portomesenteric thrombosis (widespread clotting of blood vessels supplying multiple digestive organs). Certain rare, slow-growing cancers, such as neuroendocrine tumors or leiomyosarcomas, that extensively involve the stomach, pancreas, and intestine also require MVTx. Severe motility disorders, where the muscles of the stomach and intestines fail to move food properly, can also warrant this procedure.
Surgical and Physiological Complexities of Transplantation
MVTx is among the most challenging operations in transplant surgery due to its technical complexity. The surgery requires the simultaneous removal of multiple diseased organs and the meticulous implantation of the donor organ cluster, often taking eight to twelve hours. A major technical difficulty is the complex reconstruction of vascular connections, involving joining the donor’s combined arterial patch (including the celiac trunk and superior mesenteric artery) and re-establishing venous outflow through the inferior vena cava.
A significant physiological challenge is the high risk of organ rejection, particularly from the small intestine component. Intestinal tissue contains a high concentration of lymphoid tissue, carrying a large number of immune cells from the donor. This makes the intestinal graft highly immunogenic, meaning it is more likely to provoke a strong immune response than other solid organs.
This lymphoid tissue increases the chance of rejection and carries the unique risk of graft-versus-host disease (GVHD). GVHD occurs when the donor’s immune cells attack the recipient’s body, which can be a severe complication. This dual risk necessitates an aggressive and carefully balanced immunosuppressive regimen.
Post-Transplant Care and Long-Term Outcomes
Following MVTx, patients require intensive, lifelong medical management centered on immunosuppressive therapy to prevent rejection. The regimen typically relies on the drug tacrolimus, often combined with other agents. Chronic immune suppression carries serious risks, including higher susceptibility to life-threatening infections and the development of post-transplant lymphoproliferative disorder (PTLD), a type of cancer linked to the Epstein-Barr virus.
Long-term outcomes for MVTx have improved significantly, but the procedure remains challenging. Patient survival rates for recipients are reported to be around 75% at one year and 56% to 68% at five years, though these figures vary between specialized centers. Many survivors achieve nutritional autonomy, meaning they can eat normally and no longer depend on intravenous feeding.
Recipients often face ongoing health issues, including chronic morbidities such as dysmotility (issues with muscle movement in the digestive tract), hypertension, and osteoporosis. MVTx is a life-saving measure for patients with no other options. While recovery is long and the risk is substantial, it offers a pathway to improved quality of life and sustained survival.