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South Texas’ First Pediatric Bowel Transplant
Performed (7-13-00)

Seven-year-old Rafael Ramirez was literally starving to death, the victim of a bowel syndrome since birth. He needed a life-saving operation and in March he got it—in the form of South Texas’ first pediatric small bowel transplant. The groundbreaking operation, announced July 13, was performed at University Hospital by The University of Texas Health Science Center at San Antonio (UTHSC) surgical team headed by Francisco Cigarroa, M.D., and Glenn Halff, M.D.

Born with a congenital abnormality of his small bowel, Rafael has spent all of his life under intense medical care, both in and out of the hospital, suffering from Short Bowel Syndrome and in desperate need of a small bowel transplant. University Health System, in partnership with the Health Science Center, is one of only a few medical centers in the United States to successfully perform small bowel transplant surgery.

Bowel transplantation is a relatively new treatment for patients who are unable to absorb enough food for adequate nutrition. Patients with severe bowel disease receive their nutrition from intravenous feedings called "total parenteral nutrition" or TPN. Because Rafael has been receiving TPN since birth, many of his veins were destroyed, leaving doctors with only one usable vein to feed him.

"We were in a desperate situation," said Deborah Neigut, M.D., assistant professor in the department of pediatrics at UTHSC and the pediatric gastroenterologist who cared for Rafael for the last six years. "Rafael soon would have been unable to get TPN through his veins, which ultimately would have led to starvation. He needed a transplant for long-term survival."

Neigut practiced at the University of Pittsburgh Children’s Hospital, one of the few renowned centers in the nation for small bowel transplantation, under organ transplantation pioneer Thomas Starzl, M.D. In the past Neigut had referred South Texas’ patients needing a small bowel transplant to Pittsburgh or to the University of Nebraska. "Families in San Antonio and the surrounding area were uprooted," said Neigut. "They literally ended up living there, sometimes with no family support. It was very difficult for them."

With the surgery now available in South Texas, pediatric patients in need of a small bowel transplant and their families who live in the area will not have to be uprooted. "We are opening the doors for this procedure in South Texas, " said Cigarroa, pediatric and transplant surgeon at University Hospital and head of pediatric surgery at UTHSC. "We will continue to seek excellence and innovation in organ transplantation."

In 1999, 70 small bowel transplants were performed in the United States. The surgery is performed only on patients with a 100 percent one-year mortality. According to the Texas Organ Sharing Alliance, 135 people nationwide are awaiting a small bowel transplant. Five are University Health System patients.

David Grant, M.D, performed the first successful liver-bowel transplant surgery in 1988 in London, Ontario, on a 41-year-old woman who had lost her intestine due to a coagulation disorder. The patient survived for five years. About 60 percent of small bowel transplant patients survive at least three years post-operatively; this rate is improving with newer immunosuppressive drugs.

According to the International Transplant Registry, 80 percent of patients who survive are able to stop TPN, eat normally and enjoy good health. "I predict that during this decade, intestinal transplantation will become one of the standard treatments for children with irreversible intestinal failure," said Cigarroa.

Contact: Will Sanson 210-567-2579, or Melissa Welch, 210-358-2335