Doctors perform bowel transplant; process is rare at U

Doctors performed a bowel transplant at the University on Sunday for the first time in nearly 30 years.
Rainer Gruessner, who performed the nine-hour surgery, said the patient was listed in critical but stable condition Monday afternoon. The patient is a 33-year-old Minnesota man whose bowels failed because of an illness called Crohn’s disease, which causes inflammation of the intestines and can lead to intestinal blockage.
Crohn’s is “a very crippling disease,” Gruessner said. “Most people are not able to work — even part time. They are disabled.”
Gruessner said the man received a new small intestine in its entirety. Small intestines are usually 4 to 7 yards long. The man also received about 10 centimeters of large intestine.
When University physicians performed the world’s first bowel transplant in 1967, the patient died within 24 hours. Now, anti-rejection drugs have made bowel transplants more successful.
The University of Pittsburgh became a leader in bowel transplants five years ago because it had exclusive use of a new transplant drug. The Food and Drug Administration approved the drug a year ago and since then other hospitals and universities have began performing the operation.
According to a University fact sheet, 44 small-intestine transplants were performed in the United States during the past year, and 30 percent to 50 percent of them were successful. Most of the operations were performed on children.
Often people who need bowel transplants need liver transplants as well because they must be fed intravenously and long periods of intravenously feeding can damage the liver.
“Our goal is to give a transplant to a patient with bowel disease before the liver disease develops,” Gruessner said.
The man who received a bowel transplant Sunday had been fed intravenously for about 10 months and spent several hours each day attached to a feeding tube. His veins were so damaged by the process that he couldn’t have been fed intravenously much longer.
Intravenous feeding can also be more expensive in the long run than a bowel transplant. Gruessner said the feeding costs between $60,000 and $250,000 each year.
A bowel transplant costs between $100,000 and $300,000 in the first year. If the operation is successful, a person must spend $10,000 to $15,000 each year after the procedure for medication.
A bowel transplant is more complicated than a liver or kidney transplant, Gruessner said. It is difficult to attach the new intestine because the material inside the intestine can spill and cause infection.
As with any other transplant, the patient’s body could reject the new organ. Because the intestine has many immune-system cells, the transplanted organ could reject the patient’s body.
“There are so many cells transplanted with the bowel,” Gruessner said. “Those cells can also turn against the host.”
Because the procedure is risky, doctors choose transplant candidates carefully, and the waiting list for bowel transplants at the University is small.
“I have seen 25 to 30 people for potential evaluation for bowel transplants,” Gruessner said, “and only three went on the waiting list.”
During the next three months, another three people are expected to be added to the waiting list for bowel transplants at the University.