First intestine transplant in Michigan performed on 50-year-old Port Austin patient

Sep 23 2010

The first intestine (bowel) transplant in Michigan was performed on a 50-year-old patient from Port Austin by physicians at Henry Ford Hospital.

The 11-hour surgery was performed on August 21 and 22. The composite multivisceral transplant procedure included transplant of the patient's small bowel, stomach and pancreas.

Only a few centers in the United States offer intestine transplants and Henry Ford is the only one in Michigan with a program.

The patient, Brent Patterson, who suffered from short bowel syndrome as well as insulin-dependent diabetes, had been waiting for a transplant since April.

Patterson previously had six bowel procedures in a year to treat his intestines, damaged from Crohn's disease and poor blood supply, and was no longer able to absorb the nutrients his body needed.

"I got so tired, my immune system was low and I would have to eat nonstop just to get enough nutrients," says Patterson.

Every night by 8 p.m., Patterson had to hook himself up intravenously for fluids to prevent dehydration. He was constantly at high risk for intravenous infection and multiple hospital admissions. He was also on an insulin pump for his diabetes. Five years earlier, he had a kidney transplant; his wife, Elizabeth, donated her kidney.

Since his intestine transplant, he is off of intravenous nutrition and on a combination of tube feedings and his own nutritional intake by mouth.

"I can't believe it – it is a whole new world," says Patterson. "I am not even a diabetic anymore."

The Henry Ford transplant surgical team included Marwan Kazimi, M.D., director, Small Bowel and Multivisceral Program, and Marwan Abouljoud, M.D., director, Henry Ford Transplant Institute

Dr. Kazimi explains that Patterson should have very few physical limitations: He will have to be careful with his dietary choices, especially for first few months, and make sure he stays well hydrated. Risk of rejection or infection with certain viruses is highest in first few months, and he will be monitored closely for these.

"It is our hope that he will return to fully functional status, including work and hobbies, if he so desires, and that he will never need intravenous nutrition or insulin again," says Dr. Kazimi.

The electrician/journeyman loves to rebuild race motors and is looking forward to getting back to work on his '74 red Nova and spending time with his wife and son.

"While still rare, intestine transplant is much more successful than in the past, partly due to improvements in technique and patient selection, and partly due to refinements in our understanding of immunosuppression and opportunistic infections," says Dr. Kazimi. "It is now a viable option, and anyone with short gut syndrome, chronic intravenous nutrition or fluid needs, or certain gastrointestinal disorders such as poor motility may be a candidate."

"It is an option many weren't even aware of because it wasn't available in Michigan until now," says Dr. Kazimi.

Dr. Kazimi explains patients with intestinal failure are considered candidates for transplant when other treatments, such as parenteral nutrition (intravenous replacement of nutrients) are unsuccessful. He says the most common causes of intestinal failure are short bowel syndrome that results from extensive bowel surgeries due to inflammatory bowel diseases, a chronic inflammation of the digestive tract, blood clots in the major veins that lead to the intestine, or major abdominal trauma.

Many people with short bowel syndrome, like Patterson, are dependent on total parenteral nutrition to supply their daily nutrition. Administered in the hospital or at home, intravenous nutrition usually requires a central venous catheter, which can lead to chronic infection. Over time, the intravenous nutrition solution also carries risk of complications such as venous thrombosis and liver conditions like hepatotoxicity, steatohepatitis, fibrosis and cirrhosis.

There are three types of intestine transplants including:

• Isolated Intestine Transplant for patients with short bowel syndrome and no liver disease.
• Combined Liver-Intestine Transplant for patients with short bowel syndrome and irreversible intravenous nutrition-induced liver disease.
• Composite Multivisceral Transplant for patients with short bowel syndrome requiring intestine, stomach, pancreas and/or liver transplantation; patients with portomesenteric thrombosis and liver disease; or patients with neuroendocrine tumors metastatic to the liver.

"Implementation of new techniques and technology requires several levels of preparation of such a program for patient safety and better outcomes," says Dr. Marwan Abouljoud, director of Henry Ford Transplant Institute, which has had a liver transplant program since 1989.

"The field of transplantation has been progressing rapidly with many technical innovations that help people in need of such new procedures."

Nationally, 180 intestine transplants were performed last year in the U.S. and there are currently 249 people waiting for a transplant, according to the Gift of Life Michigan. The first successful intestine transplant was performed in 1987 in Kiel, Germany.

Three other patients in Michigan are waiting for intestine transplants at Henry Ford.