By Shelagh McNally for Reflux1Freedom for Jessica Terrazas was biting into a hamburger at 9 p.m. It has been years since she’s enjoyed the simple pleasure of a family meal or been able to share a snack with friends. But an exciting joint project between Children's Medical Center of Dallas and Baylor University Medical Center allowed Jessica to survive a risky transplant that changed her life.
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Options for Patients with Intestinal Failure
TREATMENT
Special diets and medications are the usual first course. When these therapies fail, patients are placed on parenteral (intravenous) nutrition (PN). When the body can no longer get nourishment from the PN then it may be time to consider a transplant.
IV SIDE EFFECTS
Although IV feeding is lifesaving it is not ideal:
Serious lifestyle restrictions due to time needed hooked up to the IV
High cost of IV treatment
Risk of liver damage, infection
Diseases contributing to intestinal failure include:
Short gut syndrome: when most of the intestine has been surgically removed because of poor circulation, infection, trauma, tumor or disease.
Poor absorption: the intact, entire intestine is unable to absorb fluids and nutrients
Poor motility: the small bowel is unable to contract its muscles normally so that it cannot move food through the intestinal tract.
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She was 17 years old when she was diagnosed with Hirschsprung's (HURSH-sprungz), a rare congenital disease where a lack of nerve cells in the intestine prevents peristalsis (the involuntary wave-like movements of tubes in your body). Since food can’t move through the digestive system, nutrients can’t be absorbed. Gradually the colon dies off. Years of surgery to remove diseased sections had left Jessica with a dangerously shortened intestine that couldn’t absorb anything. She stayed alive by hooking herself up to an IV at 8 every night and spending 12 hours feeding intravenously. Constantly in danger of being malnourished and dehydrated, Jessica fought to remain alive. Gradually she became too weak to attend school or leave the house. At 22 she developed cirrhosis of the liver and in August 2004 she was placed on the organ recipient list for a new liver and new intestine. She was allowed to remain on the list for one year and just days before she was about to lose her place, Jessica received a call from Dr. Srinath Chinnakotla, a transplant surgeon on the medical staff at Baylor. He had found a perfect match. On August 18, 2005, Jessica underwent 10 hours of surgery while Dr. Chinnakotla transplanted a liver and small intestine.
Almost a year after her surgery Jessica remains healthy with no serious side effects – a minor miracle considering the low success rate of intestinal transplants – 50 percent or less. “I am just thankful to the donor and to my family,” Jessica said. “And to Dr. Chinnakotla – he made the biggest difference in my life. I'm a person who loves to eat now.”
Jessica’s remarkable recovery is due to the three years of research done at Baylor Institute to perfect the transplant procedure. Intestinal transplants are complicated and dangerous for several reasons. The bacterial climate in the colon must remain healthy and doctors must maintain a delicate balance suppressing the immune system just enough to prevent rejection but not so much that the bacteria escapes into the bloodstream causing massive infections.
During the 1990s surgeons abandoned intestinal transplants because so many patients rejected their new organ or never recovered from the surgery. Baylor had actually abandoned intestine transplants since 1994 after its first intestinal transplant patient abruptly rejected his new colon less than three months after surgery. They considered the transplant again after developing a successful method to manage rejections, helped by medical breakthroughs. “That we’ve been able to successfully do this complex procedure completely opens up a new arena for us,” said Dr. Chinnakotla.
A second intestine transplant was performed in April 2006 on 12-year old Trevor Webster. He too suffered a similar fate after a disease gradually killed his digestive system. After two years on an IV the teenager was slowly becoming malnourished. Too ill and weak to get off his couch, his future looked bleak. So far his intestinal transplant appears to be successful. Although limited to a low-fat, low-sugar menu, he is able to eat. “My first pancakes at the hospital were the greatest thing I ever ate…until I ate the spaghetti,” he added.
The future of the new Dallas program rests largely on these two brave transplant patients. If they continue to progress with no symptoms or complications doctors will reconsider intestinal transplants for those suffering from debilitating digestive diseases. Dr. Chinnakotla would like to be doing 10 transplants a year and is already discussing details with the next hopeful.
