“There’s no simple answer for that question,” says Dr. Ruy Cruz, surgical director of UPMC’s Gastrointestinal Rehabilitation and Transplant Program. “There’s no protocol for intestinal transplant surgery, because it’s simply not as straightforward as the heart or the kidney. It all depends on the individual patient’s situation.” Dr. Cruz is comfortable with ambiguity. Some of his patients come to him in need of small bowel replacement. Others require multiple organ transplants to restore optimal function to the intestine. Some are candidates for intestinal rehabilitation. What they do share, however, is a dependence on TPN, or total parenteral nutrition. This adequate but imperfect nutrient delivery strategy may feed the body, but it does not feed the soul. Being able to eat with family and friends is an important part of everyday life. Fixing the intestine can restore a measure of normality. Dr. Cruz is willing to figure out how to make that happen, and he starts from scratch every time. “By the time they come to us, most of our patients have already had six or seven different operations,” says Dr. Cruz. “We are their last stop.” The multidisciplinary team takes care to evaluate each patient’s status from every perspective in order to determine the best course of action, always with the goal of discontinuing or minimizing TPN. “There’s no recipe for the progression of care; it always begins with the patient’s baseline disease and builds from there. It’s complex.” An unusual aspect of Dr. Cruz’s practice is that not every patient he sees actually requires intestinal transplant surgery. Some patients benefit from intestinal rehabilitation, which can be medical or surgical and usually includes nutrition management. In every case, early referral is the most important consideration. “The sooner we see the patient, the sooner we can take action. Ideally, we can intervene before pancreatic or liver disease becomes an additional cause for concern,” says Dr. Cruz. To learn more about the latest developments in the field, visit the Gastrointestinal Rehabilitation and Transplant Program at UPMC. Editor's Note: This article was originally published on July 23, 2015, and was last reviewed on May 24, 2022.