Medicine: Intestinal Transplant

When surgeons at Manhattan’s Memorial Hospital removed a cancer from the Long Island housewife’s abdomen, they found that the growth had spread to her digestive tract. As a result, they also had to remove about 16 ft. of her intestines. The surgeons were confident that all the cancer was out. Now the question was: How could the patient be nourished?

Almost all nutrients enter the system by absorption through the walls of the small intestine, which had been removed and replaced by an emergency short circuit from the patient’s duodenum to the remainder of her colon (see diagram). The only recourse was intravenous feeding, which is rarely satisfactory for more than a few weeks, even in a hospital. And Jane Smith (not her real name), 37, was eager to go home to her two young children.

Memorial’s Dr. Maurice Shils devised a fluid diet that could supply all the protein, vitamins, minerals and carbohydrates that the body needs. A surgeon installed a plastic shunt between an artery and vein in Mrs. Smith’s leg. At home, three times a day, she connected this plastic tube to a bottle of Shils’ super-soup. Each such “meal” took three hours.

The liquid diet maintained Mrs. Smith in good health, and she actually put on weight. But then Mrs. Smith’s leg veins began to break down from repositioning of the shunts. Intravenous feeding could not go on indefinitely.

Sibling Donor. One possible alternative was an intestinal transplant. Told that only six had ever been performed, and no recipient had survived longer than 26 days, the patient said she wanted to take the chance. But where to find a donor? Jane Smith has a sister, Anne, the mother of three. Told that a healthy person can live comfortably with only half the normal length of small intestine, Anne volunteered to give half of hers to her sister. Their blood-cell types proved to be an unusually close match, reducing the probability that a graft would be rejected.

Last month the Memorial surgeons reopened Jane Smith’s abdomen. Satisfied that she was free of cancer, they disconnected their short circuit. Then they opened Anne’s abdomen and removed about five feet of small intestine (the lower jejunum and upper ileum), and used this to replace Jane’s missing tract. The surgeons also left a small, separate piece of the graft protruding through the abdominal wall, to facilitate observation of the transplant’s progress. Last week the courageous donor was eating normally, and she expects to go home within a few days. Recipient Jane, after setting an endurance record for long-term survival on intravenous feeding, hungrily looked forward to the first taste of real food destined for her rebuilt digestive system.