University of Chicago surgeons perform Hospitals' first bowel transplant

November 22, 2000

Chicagoan Larry Lewis, 24, plans to spend Thanksgiving Day at his mother's house, eating a little of her homemade turkey and a lot of dressing. It will be the first home-cooked meal he has eaten in more than 15 months.

On November 2, 2000, Lewis became the first person to undergo a bowel transplant at the University of Chicago Hospitals. He has recovered quickly from the operation, despite a few complications, and will be discharged from the hospital on November 22, 2000, the day before Thanksgiving.

More than a year ago, after his bowel was severely damaged by a blood-clotting problem, Lewis had most of his small intestine surgically removed. Without a functional bowel, he required intravenous feeding, a time-consuming process that can have multiple side effects, including liver damage.

Lewis had to wait for more than a year for a suitable organ.

"He was beginning to show signs of liver damage, which can result from long-term intravenous feeding," said David Cronin, MD, PhD, assistant professor of surgery at the University of Chicago and one of the surgeons who performed the transplant. "We wanted to get him transplanted and off of intravenous tube feedings before the liver damage got much worse and he needed a liver transplant as well."

Although doctors estimate that as many as 13,000 Americans could benefit from a bowel transplant, only about 400 have been performed. Success rates have been low. The operation is not technically difficult, but there is a shortage of donor organs and the bowel is hard to protect from rejection and infection.

Because the bowel is normally filled with bacteria, it is surrounded and patrolled by immune system cells. Contact between the donor's and the recipient's immune cells can trigger rejection of the transplanted tissue. The damage caused by this rejection can allow bacteria to escape from the bowel into the bloodstream. The medications used to prevent rejection can impair the patient's efforts to fight off an infection.

Lewis did have one rejection episode but his physicians were able to control it by adjusting his medications. He also developed breathing problems that required five days on a ventilator.

Despite these difficulties, and thanks to improved surgical techniques and better immunosuppression, bowel transplantation is becoming more common and more successful. Just last month, Medicare agreed to pay for the procedure at U.S. hospitals that perform at least 10 per year with 65 percent one-year survival.

"Paying for bowel transplantation may turn out to be a bargain," said Cronin, "even with the costs of long-term immunosuppression." Without the transplant, patients require intravenous feeding, which can cost more than $100,000 a year for many years.

Lewis' long-term goals include getting reacquainted with food, regaining his strength, and finding a job--ideally one that comes with health insurance. His short-term goals are to go home and share Thanksgiving dinner with his mother.

"I'm really looking forward to turkey and dressing," he said.

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