Georgetown Physician Update

Small Bowel Transplants Begin at GUH:
GUH Only Center in the Mid-Atlantic Approved for Procedure

Anthony Capricuso, Jr. knows that without the surgery to replace his bowel, the chances were good that he would have died from obstruction of his intestine and other organs. “My doctors had tried everything else to shrink my tumor and nothing was working. I knew removing the tumor and my small intestine and, eventually an intestinal transplant, was my only option,” he said. “It‘s been a long, long road and this is the first time the road has looked up in a long time.”

On November 8th, at 31, Mr. Capricuso received his a new small bowel at Georgetown University Hospital. This was possible because, early this fall, the D.C. State Health Planning and Development Agency (SHPDA) granted Georgetown, in collaboration with Children’s National Medical Center, a Certificate of Need to allow physicians at Georgetown and Children’s to perform life-saving small bowel transplants (SBTs). Small bowel transplantation is the transplantation of a portion of the small intestine from either a living donor or a cadaver. It is performed to restore intestinal function when the intestine has failed due to illness or trauma, and when intravenous feeding is no longer an option. An estimated 60% of SBTs are performed in children who are age 18 or under, and about 40% are performed in adults.

With this approval, the Georgetown Children’s effort becomes one of only a handful of programs in the United States that performs small bowel transplants and the only such program in the mid-Atlantic region. Though the surgical procedure offers a longer and better life to those with irreversible small bowel failure, it is still rare: only about 100 patients receive a new small intestine each year in the U.S.

Thomas Fishbein, MD, director, Small Bowel and Pediatric Liver Transplantation at Georgetown, is a nationally known surgeon in intestinal transplantation and has performed approximately 20% of all the intestinal transplants performed in the United States. His patient loyalty is such that Mr. Capricuso followed Dr. Fishbein from New York to Georgetown. Dr. Fishbein had removed Mr. Capricuso’s entire small intestine in January 2003, along with a huge, conventionally inoperable non-cancerous tumor. “Unfortunately, he suffered from Gardiner’s syndrome, a condition in which colon polyps form in such great numbers that they become cancerous,” said Dr. Fishbein. “He had his colon previously removed, then developed the tumor causing intestinal obstruction and threatening to invade other organs.” On intravenous feeding since January, Mr. Capricuso was able to eat again after a few post-operative weeks in the hospital.

Now recuperating at home in New Jersey, Mr. Capricuso visits Georgetown once every two weeks for nutritional management and to be observed for early signs of rejection - a regimen he’ll continue for about three months. He will continue to take anti-rejection medications long-term. Eating normally again, Mr. Capricuso can be expected to return to a fairly normal life, noted Dr. Fishbein, who is very pleased with his patient’s progress.
Children’s National Medical Center is participating with Georgetown in the transplant program for children as a joint clinical collaborator. Stuart S. Kaufman, MD, FAAP, medical director, Intestinal Transplantation at Georgetown University Hospital and Children’s National Medical Center, said, “This is an exciting opportunity to develop a world class organ transplantation program, particularly for the children of the Washington metropolitan area and the mid-Atlantic region.”

The Georgetown/Children’s program is part of the Georgetown Transplant Institute started in 1998 and led by Lynt Johnson, MD, chief, Division of Transplant Surgery. “We have close to 20 patients right now waiting to have intestinal transplants. This decision by SHPDA is great news for our patients, for the families in the Washington metropolitan area and the Mid-Atlantic region,” Dr. Johnson explained. Since 1993, the waiting list for SBTs in the U.S. has increased over 300%. Children make up more than 70% of the list.

“This is a logical extension of and complement to Dr. Johnson’s superb transplant team of surgeons, nurses, anesthesiologists and social workers already in place at Georgetown. Many of these small bowel patients require transplants of other organs, too, including the liver and kidney. Dr. Johnson’s program already has a proven track record in these areas,” Dr. Fishbein said.

Physicians first performed intestinal transplants in the late 1980s, but rejection and mortality rates were high. With the improvement of anti-rejection drugs, due in part to research conducted by Dr. Fishbein’s team, survival rates have improved greatly. Now, patients have a greater than 70% chance of surviving three years or longer.

M. Worley, D. Foley

Back to Table of Contents
Nov/Dec 2003