July 31, 2000
Volume XXXIII, No. 30



In Memoriam



UTHSC surgeons perform South Texas' first pediatric bowel transplant

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 a UTHSC surgical team headed by Drs. Francisco Cigarroa and Glenn Halff.

Rafael Ramirez, Dr. Francisco Cigarroa and UHS Child Life Coordinator Mike Duffy at press conference.

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 (UHS), 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 had received TPN since birth, many of his veins were destroyed, leaving him with only one usable vein.

"We were in a desperate situation," said Dr. Deborah Neigut, 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."

Dr. 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 Dr. Thomas Starzl. In the past Dr. Neigut 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 Dr. 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 move. "We are opening the doors for this procedure in South Texas, " said Dr. Cigarroa, head of pediatric surgery at the Health Science Center.

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.

Dr. David Grant 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; this rate is improving with new immunosuppressive drugs.

According to the International Transplant Registry, 80 percent of survivors are eventually able to eat normally and enjoy good health.

"I predict that in this decade, intestinal transplantation will become a standard treatment for children with irreversible intestinal failure," said Dr. Cigarroa.