Adrianna Martinez, was born without a small bowel, a rare congenital malformation that makes it impossible to digest food. With total parenteral nutrition (TPN), babies can survive by receiving most or all of their nutrition directly into the blood stream, but for reasons that are not completely clear, TPN also can lead to liver failure. She also was born with situs inversus – her abdominal organs were positioned on the wrong side – making her condition even more complex.
In a single surgical procedure on Nov. 9, 2009 at University Medical Center – the first procedure of its kind performed in Arizona and the Southwestern United States – Adrianna at age 1 successfully received a three-organ multi-visceral transplant. The liver, small bowel, and pancreas from a deceased baby donor were transplanted “en bloc” (kept together as a single unit) in the seven-hour operation, a complex procedure that is rarely performed and requires superb logistical, surgical and medical coordination.
Adrianna’s parents, Tasha Boman, 26, and Mike Martinez, 34, who live in the Phoenix area, found a family friend who had agreed to donate part of his bowel and liver, but the day before the scheduled surgery surgeons were notified that whole organs from a deceased baby donor had become available.
“By transplanting all three organs at once, we can give children with these serious intestinal diseases hope for a healthy future,” said Rainer Gruessner, MD, professor and chairman of the UA Department of Surgery and chief of transplantation at UMC. Dr. Gruessner was recruited to the UA and UMC in 2007 from the University of Minnesota. He is an international leader in abdominal transplantation who standardized the technique for living donor intestine transplants.
The transplant team included surgeons Dr. Gruessner, John Renz, MD, PhD, professor of surgery and vice-chief of abdominal transplantation, and Tun Jie, MD, assistant professor of surgery. The medical team included Khalid Khan, MBChB, MRCP, professor of surgery and a gastroenterologist specializing in pediatric liver and intestine transplants, and Thomas Boyer, MD, professor of medicine and director of the Arizona Liver Institute at the UA College of Medicine.
Dr. Renz procured the organs from an out-of-state hospital and oversaw the timing of the donor and recipient operations critical to the procedures’ overall success.
UMC is the only comprehensive pediatric transplant program in the Southwest, said Nance Conney, director of the UMC Transplant Program. The program includes dedicated specialists in pediatric surgery and transplantation; pediatric gastrointestinal medicine and nutrition; advanced-practice nursing; and child life and social support services. This range of services, essential to helping these children and their families cope with these overwhelming health problems, only is available at a few leading transplant hospitals in the nation.
Dr. Gruessner said the first year will be critical to Adrianna's survival, but so far she is doing well. The survival rate for this type of procedure is about 65-70 percent during the first year. “When these children survive the surgery and the first two months post op and do well, they can do very well long-term,” he said.