陳芸 (see photo), a pediatric surgeon and the chief of surgery at Far Eastern Memorial Hospital (亞東醫學中心) in Taiwan, recently accomplished the 5th successful intestine transplant on a young girl. We had good fortune to know her when she did the transplant research at UPMC about five years ago. We share her hard work and success with pride and delight.
The following is the link to her report, which I took the liberty to translate (as faithfully as possible) to share with my American friends,
http://www.femh.org.tw/epaperadmin/viewarticle.aspx?ID=3249
(The following is my translation)
The 5th successful intestine transplant completed the mission of the experimental clinical trial (written by Dr. 陳芸, the Chief of Surgery)
The 5th intestine transplant was accomplished in a smooth and steady manner; she has been discharged from hospital. Going through the repeated exercises and practices, our team became more familiar with these procedures; the collaboration with the other teams in the hospital was also improved. We practiced each and every step without the least hesitation; from going out to obtain the donor intestine in the early morning to early evening when the transplant surgery began until midnight when mission was accomplished smoothly. It is crucial to reduce the time of deoxygenation of the donor intestine to the very minimal. The patient was discharged after a relatively uneventful one-month hospital stay. On the day of discharge, notwithstanding there was no flash light, nor news conference, we all felt warm and exalted despite it was in the deep of the winter at the end of December. We rejoiced that she can eat again and taste the food that we all take it for granted, getting rid of the total parenteral nutrition (TPN) and all the inherent risks and complications that come with it. In addition, we finally completed the mission of the experimental clinical trial of five cases of human intestine transplant so that we now can apply to the Department of Health (衛生署) to make intestine transplant as the treatment option for those suffer from the irreversible intestinal failure.

The intestine transplant recipient was a beautiful young lady who enjoyed vigorous health until six years ago when she took sick presenting with intestinal paralysis and abdominal distention, resulting in inability to eat as she would vomit upon eating. The diagnosis of chronic pseudo-obstruction syndrome was established after consultations in many hospitals, hence completely depending on the TPN to extend her life. There have been numerous admissions due to TPN catheter-related infections or protractive vomiting; it was a pitiful young life of passing the days hooking up with a centrally placed IV catheter and an IV stand. She has been on our transplant list for several years. Her luck finally came last November when a suitable donor was found. Her intestine transplant was made possible, thanks to the altruistic love of the donor, bringing about the hope of a new life. (The photo was taken with the patient post-op Day 20)

(photo shows attentive concentration on doing intestine transplant) The dire reality is that most victims of the irreversible intestinal failure are not so lucky the past few years. For various reasons such as the weight or the young age and the incomplete data of the clinical trials, they perished or are still on the waiting list for the suitable donors. The one that impressed me most was a young boy of 13 or 14 years of age, who could be trusted about medicine taking, the timing of TPN catheter or wound dressing change. He went online searching for relevant info. One can discuss with him like one does with an adult; he is acquainted with bacterial cultures and various laboratory tests. I once asked him why not stop the TPN (intravenous infusion of nutrition via a centrally placed catheter) for a few hours in the day time, he responded by saying matter of factly, “I am afraid of stopping as it would increase the numbers of set changing, thus increases the chance of infection; [rightly so] besides I am running out of venous access sites.” It saddened me and made my heart ache upon hearing it. He asked me, “Can I eat again once I have an intestinal transplant?” To which I said, “Of course, you can eat once transplant is done.” He took a glimpse of his mother and smiled, however brief it might be, it was a hearty and exultant smile. That was the only smile we had seen on that outpatient visit. A few days ago a friend of mine shared a theory of being grateful counting our breathing; we should feel blessed and thankful as long as we can breathe in and out of the air. For the same token, to be able to eat and taste the food is a god-given blessing; we tend to take it for granted. The more we want the more discontented and less happy we become. Seeing and taking care of these patients with the irreversible intestinal failure, one learns again the value of the life and true happiness. Contentment is the key so to speak.
It depends on the help from many people in accomplishing the clinical trial of intestine transplant; the first and foremost, the support of our hospital CEO (朱樹勳院長). I began the project of animal intestine transplant once I returned from doing the transplant research at the University of Pittsburgh Medical Center (UPMC—an eminent transplantation center in the U.S.), 朱院長 personally guided and presided over the project. Whenever the difficult bottlenecks were encountered, it was the leadership and perseverance of朱院長 that brought back my confidence and hope and successfully broke through the barriers. Without his support the mission is impossible. I also want to express my appreciation to the team of the surgeons: Dr. 吳建明 and Dr. 陳信安 co-direct this project, Dr. 邱冠明 (also the chief) of the cardiovascular center; their super surgical technique is an eye opener and help my own learning and professional growth. In addition, the operating room nurse, 張沁芸, the very “soul” of the operating room, who kept the operations running smoothly in perfect coordination. The anesthesia staff (林子鏞主任 and Dr. 吳佳展) were the heroes behind the scene; their astute and skilled anesthetic technique allowed us to concentrate on our job without worry. I would be remiss without mentioning the team provided the post-op care: Dr. 張碧峰 (also the chief) of pediatric gastroenterology division and Dr. 李宗熙 (also the chief) of adult gastroenterology division, who provided the scope examinations, and Dr. 蔡建誠 (also the chief) of pathology department, who kept a vigilant eye to make sure the tissue rejection was not in the making. It was indeed a long journey of the past 5 years that our team began with the intestine transplant for the pig to progress and evolve to the human.
The marvelous care provided by the staff at Ward 4D and surgical intensive care unit under the direction of 洪芳明主任 made the post-op recovery and rehabilitation progress smoothly. The help from the social service and the organ harvest team was also indispensable. Last but not least was the nurse, 翁家琪, who did pretty much anything and coordinated everything that made the success of this difficult task possible. I also want to mention many behind the scene heroes that included, but not limited to pharmacist, nutritionist, the researchers in the laboratory (心怡, 雅慧, 怡惠, 世華). Thanks to all!

The intestinal transplant is the most difficult among the organ transplantations as it contains lymphatic tissue, making it vulnerable to organ rejection. The favorable results has been slowly achieved over the past 10 years; as of now there have been more than 2,000 cases of intestinal transplants across the globe, mostly done at the top-notch European and American medical centers, isolated cases have been reported in Japan and China. The Far Eastern Memorial Hospital (亞東醫學中心) is the only medical institution that has done intestine transplant in Taiwan, demonstrating its outstanding capacity in delivering excellent healthcare. (photo shows the team work of the surgical team doing intestine transplant)
Our hospital CEO, Dr. 朱樹勳, who was the first in doing heart transplant in Taiwan and who introduced heart transplant to the field of organ transplantation at the Far Eastern Memorial Hospital, the project has since extended to heart, kidney, cornea, small intestine and liver transplant, making it the best equipped and most comprehensive organ transplant hospital in Taiwan. It is our hope that, after completing the pilot study of five cases of successful intestine transplant, the intestine transplant can be available for routine clinical service in Taiwan, making it the Last Best Hope for ones with the irreversible intestine failure.