In a rare living-donor transplant, a four-year-old from West Chicago, Ill. received a segment of his mother's small bowel during surgery at the University of Illinois Medical Center at Chicago on Oct. 24.
"This is the first time a living-donor small bowel transplant has been performed successfully on a child this young or this small using a bowel segment long enough to support an adult," said Dr. Enrico Benedetti, associate professor of surgery at UIC and division chief of transplantation surgery, who performed the operation. "Until recently, living-donor small-bowel transplantation has been reserved for adult patients due to the technical difficulty of transplanting an adult-sized graft into a child.
"We used a technique that allows us to slowly introduce the small bowel into the abdomen without compromising function of the organ. We already know that using a living-donor graft is superior to using a cadaveric graft for small-bowel transplantation because the risk of rejection and infection is greatly reduced," he said.
Zachary Connard, the transplant recipient, was born with gastroschisis, a congenital defect of the abdominal wall in which all or parts of the small intestine and other internal organs are on the outside of the abdomen with no protective sac. The defect occurs in approximately 1 in 10,000 births.
In most cases, it can be repaired with surgery after the child is born, but in a few cases, the amount of damage to or loss of intestine causes further complications.
Prior the transplant, Zachary had undergone 22 operations to repair the defect, which included attempting to place the small bowel back inside the abdominal wall. In addition, he suffered from numerous complications, including adhesions, which caused recurrent bowel obstruction that eventually required the surgical removal of nearly all of his small intestine.
Without a normally functioning small intestine, Zachary could not digest food or absorb feedings. He continued to lose weight and became extremely ill. His liver was also failing as a result of total parenteral nutrition. At the time of surgery, he weighed just 24 pounds.
In a life-saving procedure, UIC surgeons removed five feet of Zachary's mother Angie Connard's small bowel during a two-hour operation, leaving her with approximately two-thirds of her small intestine. In a nearby operating room, surgeons spent the next six hours preparing and transplanting the graft into her son.
The section of small intestine required to support Zachary as he grows is too large for his abdomen, but surgeons have developed a technique which leaves part of the graft temporarily on the outside of his body. The small bowel is covered with a slowly dissolving mesh, which will be covered with a skin graft sometime in the next several days.
Dr. Mark Holterman, assistant professor of surgery and division chief of pediatric surgery, has cared for Zachary since he was an infant, performing all of the boy's previous 22 surgeries.
"I didn't have anything else to offer this patient or his family," said Holterman, who was part of the surgical team that performed the transplant. "This surgery is an answer to my prayers and I'm grateful that we have the expertise and technology available at this time as an option for Zachary and other patients."
Both Zachary and his mother Angie are doing well following surgery. Angie was discharged from the hospital three days after surgery and has had no complications. Zachary remains in the hospital and continues to improve with his mother by his side. According to Angie, Zachary is enjoying eating ravioli and french toast again and is anxious to get home to play with his 2-year-old brother, Chaz.
Based on Organ Procurement and Transplantation Network data as of July 31, only three other patients under age 18 have undergone this type of procedure in the United States. One of the three patients is still alive.
UIC is a leader in adult living-donor small-bowel transplants, performing more than any other center in the country. Only nine adult patients have received living-donor small-bowel transplants in the United States. Five of these patients were transplanted at the medical center.
For more information about UIC, visit www.uic.edu
For more information about University of Illinois Medical Center at Chicago, visit www.uillinoismedcenter.org
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