University of Utah seeks bowel transfer ability

Intestines: Adding the organ to the transplant program is in the works

By Carey Hamilton

The Salt Lake Tribune

August 29, 2006

While still rare, transplants of cadavers' intestines into patients with digestive disorders is growing, and the University of Utah plans to add the practice to its transplant program.

"There is a need for it in patients with short bowel syndrome and who have no other therapeutic option," said Phil Sahm, a spokesman with University Health Care.

The U. now does transplants of kidneys, hearts, lungs and livers. The next technique it plans to develop is pancreas transplantation, "because the need for that service is greater," Sahm said, but it also expects to apply to Medicare for permission to start intestinal transplantation.

John DiBaise, associate professor of internal medicine at the Mayo Clinic College of Medicine in Scottsdale, Ariz., spoke about intestinal transplantation at the U. last week.

He said it is most promising for people suffering from short bowel syndrome, which is the malabsorption of food nutrients from disease or surgical removal of parts of the small intestine, and pseudo-obstruction, a problem in which the muscles and nerves in the intestines don't work properly, causing cramps, nausea, vomiting and malnutrition.

"These are rare conditions, but they are very serious," DiBaise said.

Bowel transplantation was first attempted during the 1960s, according to the Intestinal Transplant Registry. Patients then were dying of starvation after having sections of bowel removed because of disease or trauma. Intravenous feeding was not yet available. The first intestinal transplant patients died from such complications as rejection and infection.

Today, 30 centers in the U.S. do various types of intestinal transplantation surgery. The closest to Utah are Stanford University and the University of California at Los Angeles. The University of Washington in Seattle also has a program.

In 2000, doctors in the U.S. performed 76 intestinal transplants; that number grew to 171 last year, according to the U.S. Scientific Registry of Transplant Recipients. Still, intestinal transplant surgeries are the second least common, trailing heart-lung transplants.

Patients may require a small bowel transplant alone, a small bowel and liver transplant, or a small bowel, liver, pancreas and stomach transplant. Referred to as bowels, the small intestine absorbs nutrients from food and the large intestine absorbs water and salts.

Donors are usually dead, although there are some instances of living donors. Intermountain Donor Services in Salt Lake City works with transplant centers around the country and has helped match deceased donors with bowel transplant recipients in other states.

"We don't have anyone on Utah's waiting list because no one does [intestinal transplants] here, but we do recover intestines," said Liz Roach, the group's director of professional education.

David Nemelka, founder of the Quest for the Gift of Life Foundation in Mapleton, an organ-transplant advocacy group, said he was glad to hear the U. plans to expand its program. He said LDS Hospital and the U. are leaders in the nation when it comes to transplants.

"Medically, they're making progress, but there's still more to do," Nemelka said. "I'm convinced it all can happen if the money is there and the medical knowledge is there."

The average cost for the operation is $250,000. The one-year survival rate for adults is 81 percent, compared with 79 percent for pediatric patients. Children account for 60 percent of the cases and usually have a congenital defect.

Copyright © 2006 The Salt Lake Tribune.

This article posted September 2, 2006.