UA Surgeons Perform Arizona’s First Intestine Transplant

TUCSON, Ariz. – Surgeons at The University of Arizona Department of Surgery performed Arizona’s first intestine (bowel) transplant April 30 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.  The patient, Leslie Richter, a 44-year-old woman from Rio Rico, is recuperating at the hospital. 

Richter became ill last year when she developed a potentially fatal condition that twisted her intestine, completely blocking the blood flow and destroying the organ.  Except for 5 inches, almost all of her intestine had to be surgically removed. 

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 substantially shortened, people suffer from severe dehydration and malnourishment and require total parenteral nutrition (TPN) — receiving all nutrients through an intravenous line. 

Richter’s quality of life and long-term survival looked bleak.  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. 

An intestine transplant replaces a patient’s surgically removed or diseased small intestine with one from either a living or deceased donor.  Such transplants are life-saving, yet rare; they are available at only a handful of U.S. medical centers.  Even more rare are living donor intestine transplants, whose benefits for the recipient include no wait list time, the ability to plan for surgery under optimal circumstances, and a potentially longer graft survival time (studies of living donor kidney transplants have shown that living donor organs seem to last twice as long as deceased donor organs).

Told that a healthy person can live comfortably with only one-fourth to one-third of the normal length of small intestine (provided 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.

The intestine transplant surgical team was led by Rainer Gruessner, MD, professor and chairman of the UA Department of Surgery, who standardized the technique of living donor intestinal transplant, and John Renz, MD, PhD, a UA professor of surgery and vice chief of Abdominal Transplantation. Another key member of the team is Khalid Khan, MBChB, MRCP, a UA associate professor of surgery and pediatrics and a nationally renowned 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,” said Dr. Khan.  “Having the transplant means that Mrs. Richter will be able to eventually eat food normally again.  The transplant should give her her life back.”

“We now have the infrastructure in place at UMC to offer highly complex, life-saving organ transplants, such as intestine transplants,” said Dr. Gruessner.  “UMC offers the most comprehensive transplant program in the state.  We regularly perform kidney, pancreas, liver, lung and heart transplants, including living donor transplants, and soon will be offering islet cell transplants.” 

Nance Conney, UMC director of Transplant Services added, “We have the only pediatric transplant program in the Southwest.”

According to the national Scientific Registry of Transplant Recipients, 55 intestine-only transplants were performed in the United States lastyear, and 234 people in the United States currently are waiting for an intestine-only transplant.

“We are thrilled to bring this important life-saving procedure to our area,” said Dr. Renz. “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 and we are proud to be able to help patients like Mrs. Richter.”

“Mrs. Richter underwent this life-saving bowel transplant before she could develop liver failure – in which case she would have required a combined intestine and liver transplant. However, many patients never get transplanted because of the scarcity of decease 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,” said Dr. Gruessner.

Submitted on behalf of University Medical Center
People on TPN who are interested in more information on intestine transplants can contact the UMC Transplant Program, (520) 694-6152.

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