Abdul Wahid Al-Mushaikhs
Has a person become in the tradition of modern surgery a large machine when a part in it is damaged that must be replaced by a suitable spare part in the place of the required part? Mrs. Davis was not convinced by the opinion of the British specialists in the case of her 4-year-old daughter "Laura", who suffers from liver and small intestine failure, so she collected donations. The various British media helped her a lot, as she sought out the condition of her daughter, who was unable to treat her, so she turned to the sympathy of all the British people, which enabled her to collect huge sums in a short period of time. Mrs. Davis took her daughter to Pittsburgh, USA. There, doctors transplanted a small liver and intestine at the same time to baby "Laura". International news agencies reported the news of the medical scoop and people following the case were glad, while British doctors received the matter with great reservation. However, sadness once again fell on the heart of everyone who followed the story of "Laura Davis" when the doctors declared that her condition was very serious after the failure of her transplanted organs, and "Laura" died weeks after the operation. The story of "Laura Davis" drew attention to the great difficulties facing Small intestine transplant, what are the difficulties and is there cause for hope?
The small intestine extends from the end of the duodenum to the end of the jejunum and the beginning of the cecum. Some researchers may count the duodenum as part of the small intestine. Its length varies from person to person, but the average length at birth is 250 cm, while the colon length is 50 cm. The average height in adults is 600 cm, and the colon 150 cm. It is worth noting that a person can live normally with an amount of 30 cm from the small intestine if he also leaves the valve between the jejunum and the cecum. The major function of the intestine is to absorb the main components of digested food. If the intestine fails, this important function is disrupted.
Every year, about 50 people in Britain alone suffer from the failure of the small intestine, which requires the provision of the food they need through a catheter placed in one of the major veins in the neck. For such patients, there is a ray of hope emerging in the sky of transplant surgery is the small intestine transplant. However, the success of such an operation today is still insignificant due to a number of difficulties. The story of "Laura Davis" is testament to this.
Laboratory experiments in the late 1950s demonstrated the possibility of small intestine transplantation, but immunosuppressive drugs to prevent the mechanism of rejection of the transplanted intestine at that time had not yet reached the level of development it is now. The first human transplant was in 1967 at the hands of Lillehei, but death was the donor''s ally. In the sixties and seventies, some incurable and hopeless cases forced some researchers in Europe to perform small intestine transplantation operations that did not survive for a few days because of rejection, deadly infections and blood poisoning. In 1989, Deltz performed the first successful transplant, using the intestine of a living human being.
Among the diseases that afflict the intestine that lead to its failure and thus to the need for transplantation: Small Bowel Atresia, Torsion of the intestine, which leads to the collapse of the intestine, Volvulus Small Bowel, and Necrotizing Enterocolitis, in children. In adults, the most important disease This is Crohn''s disease and the chronic need for intravenous feeding due to loss of the small intestine for any reason such as mesenteric thrombosis and surgical excision.
The intestine, along with other organs such as the liver, heart, kidneys, pancreas, and corneas, is taken from a patient whose condition was diagnosed with brain death for any reason, provided that there is consent from the patient before his death or from his closest relatives to donate his organs without any financial compensation and willingly. For a donor with his intestine, what is required of any organ donor is that his general condition be stable in intensive care and that he does not suffer from blood poisoning or malignant cancerous diseases, "an exception to this is brain tumors" and that he does not have any disease affecting the small intestine. It is also required that his blood type and weight match the blood type and weight of the donor. The donor may be a living human being from the donor’s close relatives. A part of his small intestine is taken that does not affect his health and is sufficient to solve the patient’s basic problem.
There are obstacles that make the success of this type of transplant less optimistic than transplantation of other organs. The most important of these is the physiological and histological structure of the small intestine, as it consists of a tube lined with a membrane wall that contains glands that secrete a huge amount, amounting to 6 liters per day, of enzymes necessary for digestion as well as a large number of lymph nodes. Enzymes make preserving the donated intestine before transplantation difficult because these enzymes digest the organ. As for the lymph nodes, they act as a stronghold for the cells that fuse the war of rejection against the new organ transplanted as a foreign body. In addition, one of the most important functions of the small intestine is to absorb food and preserve bacteria inside the intestine, as its insulating wall acts as a protective shield that prevents these bacteria from passing into the peritoneal cavity and then into the blood. In the early stages of transplantation, it may be impossible for the transplanted intestine to be able to fully perform these two important functions, which makes the bacteria in the intestine able to penetrate this protective wall, causing poisoning that results in failure of other important organs that result in the death of the patient.
The body may reject the new intestine as strange despite the use of immunosuppressive drugs. But the rate of rejection is lower if some new drugs such as FK506 and immunosuppressive drugs are used, and they are also not without complications, especially if they are given in high doses to reduce the rate of rejection that exceeds others after other organ transplantation. Also, 15% of patients who have a bowel transplant are exposed to developing lymphoma more than others. And that when transplanting the intestine, an Ileostomy must be made in the lower right part of the abdomen. Although this stoma is very important for diagnosing rejection cases, it may be accompanied by a significant number of complications, including contractions, prolapse, bleeding, loss of large quantities of fluid in the beginning and others. Then there is the baffling question, what should be done if the body chronically rejects the new intestine? All these matters must be balanced with the benefits that the patient may benefit from from transplantation, the most important of which is the elimination of parenteral nutrition. Therefore there are several aspects of bowel transplantation that need convincing answers.
The eighties witnessed important developments in the science of transplantation, which brought about a revolution that was scarcely seen in the medical world this century. These developments have reignited the enthusiasm of researchers in transplantation of intestines, after despair took them all. The most important of which is the discovery of the immunomodulatory drug Cyclosporin by Calne in Cambridge, Britain, in 1984, which improved the results of many organ transplantation. The results of simultaneous liver and small intestine transplantation for patients with liver and intestinal failure presented by Grant and his colleagues in 1989 encouraged researchers in Pittsburgh to conduct a comparative study of patients who received liver and intestine transplantation simultaneously and were treated with cyclosporine and those who were treated with a drug The new GK506. These researchers have found that the outcomes for patients treated with FK506 are significantly better than others. Also, the results of simultaneous liver and intestine transplantation for patients with liver and intestinal failure are better than single intestine transplantation for patients with intestinal failure only.
Since the obstacles have now been known, and the encouraging initial results of small intestine transplantation in light of the tremendous development that has been made in the science of immuno-lowering drugs and in organ-preserving solutions, as well as in the surgery itself, there is a glimmer of hope. It is hoped that researchers will be able to find ways to improve outcomes for those in need of a bowel transplant only. In this type, which is considered one of the most complex transplantation operations, the road may be fraught with many difficulties and frustrating failure, but we must bear in mind the fact that what was a dream of yesterday will be the reality of today will be a routine tomorrow, and this is what really happened in the transplantation of other organs such as the liver Heart and kidneys. However, the major problem in the science of all organ transplantation remains the scarcity of the number of donors with their organs and the large number of people in need of transplantation, which increases the gap between them day after day. Without a solution to this problem, the science of transplantation remains beneficial to the long-awaited patients on the waiting list, without the availability of suitable organs for them, and they died while waiting.
