Intestinal transplants area rare, in fact less then a dozen have been preformed on area patients since the process was perfected in 1987. The difficulty for those who need the surgery is that it is not performed in Houston and most of those who need it are children. Because they are often very sick and post operative complications are usual, they are forced to stay away from home for an extended period of time. That burden will eased as the procedure will soon be done in the Medical Center.
Surgeons at The University of Texas Medical School in Houston and Memorial Hermann Hospital will be the first in the region to offer this life saving operation. Dr. Bob Saggi is a member of the transplant team. He says patients who suffer small bowel failure are usually on total parenteral nutrition.
“It is a means of feeding patients by IV, essentially those patients who have short gut syndrome or other forms of intestinal failure that result in inadequate surface area of the intestinal tract to absorb nutrients, fluids and electrolytes. So, essentially, these patients can’t eat to nourish themselves and hydrate themselves and have to be on this TPN.”
Dr. Saggi says about 80 percent of patients on TPN do just fine, but about 20 percent suffer intestinal and often liver failure.
and when they get to that point patients have a limited life expectancy. In fact the patients waiting intestinal and liver transplant surgery have the highest mortality while waiting for an organ transplant of any other organ in the United States including heart and lung.
This is complicated by the fact that about 60 percent of patients are children under five and most of that group is under three-years-old.
“The problem with children is that because of improvements in pediatric preventive care, we have fewer and fewer, thankfully, organ donors in the pediatric population. We also have to have a relatively small donor because when these patients are transplanted we have to have a donor who is about three-quarters the weight of the recipient, and that limits the availability of organs for these patients.”
The need to travel a great distance for the transplant makes the process even more physically and mentally stressful.
“The most local center that is established is in Omaha, Nebraska at the University of Nebraska. It’s a very good program, however, it is hours away. These are very complicated procedures and very sick patients, and as a consequence they often have to stay for a period of six months, assuming there are no complications, in the area where they are transplanted. That’s often an undue hardship on families financially and from a personal stand point.”
Dr. Saggi says intestinal transplants are not experimental, but they are cutting edge surgery. Recuperation is long because the patients are so sick, the high rate of rejection, and the complications of treating rejection. He says the rejection rate improves all the time because surgical techniques and medicines are improving.
The UT Houston transplant team is evaluating potential transplant patients and has several on the organ donor waiting list.