Intestine (+ Liver etc) Transplant
Although transplant can address the original problems, it can also create new ones. Here is one brief summary of the major issues involved in the transplant process, based on a presentation by Beverly Kosmach at the Pittsburgh center:
At the most general level, the issue with transplants is balancing between two major threats (a rock and a hard place): rejection and infection. The balancing dial is set by immunosuppressant drugs: more suppression helps eliminate rejection, but opens up the system to infection. The other major factor is time: rejection is a much bigger problem early on, and then the system adapts and lower levels of suppression can be used. Thus, after navigating this balancing act for a couple of years, the suppression levels are typically low enough that infection is not a significant concern relative to the rest of us. The trick is making it through the first year or two. The reason they keep the kids in the hospital for 6 months after the transplant is because there will be several infections from both bacteria and viruses, and there will be episodes of rejection, as they get this balancing act sorted out. They just have to stay on top of these things in an intensive care setting: detect early and treat quickly. With improvements in antiviral and antibacterial medications, plus better more selective immunosuppression medications (tacrolimus/prograf and thymoglobulin, pioneered at Children's Hospital Pittsburgh), they have achieved 100% survival rates for the first 18 months in their latest series of 74 patients. This is very encouraging. Nevertheless, some people do develop chronic rejection and infection problems, and parents' ability to stay on top these things is variable and not as good as an intensive care unit. Thus, the rate falls to 86% survival after a few years.
The statistical data show that transplants at major established centers have a higher success rate. There are 40 hospitals in the US that have ever done a small bowel transplant. There are 7 hospitals that have been approved by Medicare to do small bowel transplants (minimum volume and minimum outcomes) Those 7 places (in order) are:
1) Children's Hospital Pittsburgh - We like Pittsburgh very much for Transplant. AustinRath is listed here. The staff are great and very good medical care by the surgery team. The team in Pittsburgh does tend to encourage transplanting healthier kids that other centers may say aren't critically in need of a transplant.
3) University of Nebraska
4) Mount Sinai School of Medicine
7) Indiana University (busy, but new)
Others with active programs include:
Hopefully people with relevant experience can comment on these.
- Scientists tissue engineer human intestines and functioning nerves (ScienceDaily, Nov 21, 2016)
- Artificial Gut May Be on the Horizon (MD Magazine, Oct 22, 2015)
- Tissue-engineered colon from human cells develop different types of neurons (EurakAlert!, Oct 1, 2015)
- Human intestine grown in mouse for first time as scientists say there is hope to create 'spare parts' for people (The Independent, Oct 21, 2014)
- One Day, Growing Spare Parts Inside the Body (NY Times, Sep 17, 2012)
- Gut on a chip could help in the study of digestive disorders -- not necessarily relevant for transplant specifically, but for the study of gut disorders more generally.
- GROWING MINI-INTESTINES IN A DISH (Stanford Medicine Magazine)
- Intestinal tissue created from stem cells (The Mainichi Daily News)
- Re-growing organs for transplant from patient's own cells (clinical trial)
- Progress toward organ transplants without lifelong immunosuppressants, by identifying patients whose bodies have accepted their transplants.
- Omega-3's decrease rejection of small intestine transplants in rats: Omega_3_and_transplant.pdf (Kun Et Al, 2008, Journal of Parenteral and Enteral Nutrition). Boston Children's apparently now has many of their transplant recipients on enteral fish oil.
- Bone marrow could stop organ rejection -- it's not clear this would work with the intestinal immune system, but this represents more general progress on the transplant front
- Organ Procurement and Transplantation Network
- United Network for Organ Sharing
- US Transplant -- scientific registry of transplant recipients -- this site seems to have the easiest way to get success data by specific centers. E.g., go to: http://www.ustransplant.org/csr/current/csrDefault.aspx and enter Intestine and Table 11 to see 1 yr survival by center.
- Information for kids about transplants