Richter survived the surgery, but her quality of life and long-term survival looked bleak. She no longer could eat or drink by mouth.
The small intestine is a tube between the stomach and the large intestine that helps the body digest and absorb the fluids and nutrients in food. When the small intestine is shortened substantially, people suffer from severe dehydration and malnourishment and require total parenteral nutrition, or TPN, receiving all nutrients through an intravenous line. People on long-term TPN are at risk of developing liver failure and infections, complications that are life-threatening.
Her only alternative was an intestine transplant.
Told that a healthy person can live comfortably with only one-fourth to one-third of the normal length of small intestine – provided that the large intestine remains intact – Richter’s sister, Michelle Teran, volunteered to give a portion of hers. Their blood cell and tissue types were a good match, reducing the probability that the graft would be rejected.
On April 30, 2009 surgeons at the University of Arizona Department of Surgery performed Arizona’s first intestine (bowel) transplant on Richter in a successful nine-hour procedure at University Medical Center. The procedure also was the first intestine transplant using a living donor in the entire Southwest.
“Mrs. Richter underwent this life-saving bowel transplant before her liver dysfunction progressed to end-stage liver failure – in which case she would have required a combined intestine and liver transplant,” said Rainer Gruessner, MD, the intestine transplant surgical team leader. “However, many patients never get transplanted because of the scarcity of deceased donor livers.”
“We encourage patients on TPN to contact us before they develop liver failure so that they can undergo an intestine transplant in time,” he said. Dr. Gruessner, chairman of the UA Department of Surgery, standardized the technique of living donor intestine transplantation in the 1990s.
“We are thrilled to bring this important life-saving procedure to our area,” said professor of surgery John Renz, MD, a member of the transplant team and vice chief of Abdominal Transplantation. “A strong transplant program ensures that patients in the Southwest in need of a transplant receive world-class care. The commitment to saving lives through donation and transplantation is unparalleled; we are proud to be able to help patients like Mrs. Richter.”
Another key member of the team is Khalid Khan, MBChB, MRCP, a UA associate professor of surgery and a nationally renowned pediatric gastroenterologist specializing in liver and intestine transplantation.
“Intestine transplants have gone from a procedure many considered improbable in the 1990s to one today that offers patients greatly improved chances of long-term survival and a better quality of life,” Dr. Khan said. “Having the transplant means that Mrs. Richter will be able to eventually eat food normally again. The transplant should give her her life back.”