UT Physicians Offer First Intestinal Transplants in Houston

Surgeons at The University of Texas Medical School at Houston and Memorial Hermann Hospital-Texas Medical Center will be the first in the region to offer life-saving intestinal transplants to children and adults with irreversible small bowel failure.

Bob Saggi, M.D.

The team is composed of Luis Mieles, M.D., professor of surgery and director of liver transplantation in the Division of Immunology and Organ Transplantation; Hadar Merhav, M.D., associate professor of surgery; Bob Saggi, M.D., assistant professor of surgery; and Ruben Quiros, M.D., associate professor of pediatric gastroenterology and hepatology.

They are evaluating patients, and the team already has several patients on the waiting list for a small bowel transplant.

“The results from intestinal transplantation are the best they have ever been,” Saggi said. “In the early years, there was a high complication rate from rejection and infection, but the surgical technique and medications have advanced, making it a safer, viable option.

“The survival rate is increasing, and the results are only going to get better as we improve methods of diagnosing rejection and preventing or treating rejection,” Saggi said. “Also, as our results improve, we can justify transplanting patients earlier, when they are less critically ill. Earlier transplantation will lead to better results in and of itself.”

Small bowel transplantation is performed to restore intestinal function when the intestine has failed due to illness or trauma and when intravenous feeding is no longer a safe option because of related complications or when the quality of the patient’s life is extremely poor.

Nationally, approximately 200 patients are waiting for a small bowel transplant, and few medical centers
offer the procedure. To date, only five small bowel transplants have been performed in Texas. An estimated 60 percent of small bowel transplants are performed in children, with the remainder done in adults.

Diseases commonly leading to intestinal transplantation in adults are short-gut syndrome caused by
trauma, Crohn’s disease, cancer, intestinal ischemia and other disorders that cause poor intestinal function or the loss of massive amounts of the gut.

In children, the diseases leading to transplantation are gut loss due to premature birth or neonatal critical illness, congenital disorders and neuromuscular diseases of the intestinal tract.

Patients with severe disease cannot eat and require total parenteral nutrition, which delivers nourishment through an intravenous feeding tube. Most children and adults with intestinal failure do well on total parenteral nutrition, but an estimated 20 percent eventually develop complications and no longer are able to tolerate total parenteral nutrition. With no other way to absorb nutrients, a transplant may be the patient’s only option for survival.

Sixty to 70 percent of patients who are candidates for an intestinal transplant also have liver damage that
requires transplantation of the liver, Saggi said. The team offers this combined transplantation.

Patients who have no complications can expect to stay two to six weeks in the hospital following the surgery. “Within a month, most are eating or taking tube feeds,” Saggi said. “For children who have never
been able to eat before, it may take a little longer because they have to learn to eat.”

Opening a small bowel transplant program in Houston will be of tremendous value to patients who
otherwise would have to travel great distances for a transplant and follow-up care.

“Most complications, such as organ rejection or infection, occur within the first six months, so the patients will be required to stay close to the medical center for an extended period after they leave the hospital,” Saggi said. “That way we can provide rapid diagnosis and treatment if complications occur.”
Quiros added, “Historically, children have had to travel out of state for transplants, and it was hard on
them and their families to be so far away from home. Plus, if they developed a complication, they had to get on a plane to see their doctor. This delay in treatment can be very dangerous to the patient.”

The survival rate one year after a transplant is 70- 75 percent, Saggi said. The three-year survival rate is 50-60 percent.

Concurrent with the small bowel transplantation program is the opening of the Intestinal Rehabilitation
and Transplant Clinic at Memorial Hermann Texas Liver Center. Saggi said the weekly clinic at the UT Professional Building, 6410 Fannin, and the transplantation program allow for a comprehensive treatment plan for patients with disabling and life-threatening intestinal disorders and liver disease. A dietician, transplant coordinators, a nurse practitioner, social worker and neuropsychologist are on staff. Together, the services will lead to better clinical outcomes, he said.

The intestinal transplant program has been in development since Saggi arrived at the UT Medical School in July 2004. Saggi gained experience in this specialized field of transplantation during a clinical fellowship at David Geffen School of Medicine at the University of California-Los Angeles. Quiros also received intestinal transplant training at UCLA and specializes in pediatric gastroenterology, hepatology and chronic total parenteral nutrition management.

Mieles and Merhav gained experience in small bowel transplantation at the Thomas Starzl Transplant
Institute in Pittsburgh, where the field of intestinal transplantation started in the late 1980s. For an
appointment call 713-704-6800 or 800-98-LIVER.

By Meredith Raine, Public Affairs