UMC’s sister-to-sister operation gives patient new small intestine
The sisters looked at each other and nearly broke into tears.
Michelle Teran had donated 6 feet of her small intestines to her ailing sister, Leslie Teran-Richter, on April 30. But, as the women shared a quiet moment Friday afternoon, the donor beamed as brightly as the recipient.
Teran-Richter, 44, nearly died in October when her small intestine twisted itself into knots after a sudden illness. Blood stopped flowing to the tangled organ, and the tissue began to die.
Doctors removed all but 5 inches of Teran-Richter’s small intestine. She faced a lifetime of intravenous feedings and the ever-present risks of infection and other complications.
“I couldn’t let her do it,” Teran said of the prospect of seeing her younger sister languish in such a state.
Though 12 years older than Leslie, Teran said the siblings have remained close. “There was no hesitation to do the right thing,” she said.
Doctors at University Medical Center had never performed a small intestine transplantation. No hospital in the state, or in the Southwest, had attempted such a risky procedure.
Nationwide, doctors perform between 150 and 180 bowel transplants, according to surgeon Rainer Gruessner, who led the team of doctors who operated on the sisters at UMC. Even fewer intestine transplants involve living donors. Almost all include transplanting other organs at the same time.
Small bowel transplants carry greater risks of rejection and infection than transplants of other organs, Gruessner explained.
Spending a lifetime requiring total parenteral (intravenous) nutrition could cost up to $200,000 a year, according to gastroenterologist Khalid Khan, a member of the UMC transplant team.
“That’s just really the nuts and bolts,” Khan said.
Long-term intravenous feedings can increase a patient’s risk of liver failure, Khan said. The cost of caring for patients in that state can top $500,000 annually.
UMC worked with Teran-Richter and her family to convince insurers that a transplant, which would cost $20,000 to $30,000, would be the most cost-effective option.
Once the doctors got the OK, the operation went smoothly.
As surgeons on Friday wheeled Teran-Richter into a UMC conference room, she cracked jokes about how much makeup she put on that day.
She said she’s in a great deal of pain. For the next several weeks she’ll undergo weekly biopsies to determine the continued viability of her newly transplanted bowel. She’ll remain on anti-rejection drugs the rest of her life.
“That is almost a minor issue,” Gruessner said.
About two-thirds of patients who receive small-intestine transplants live well past their first year with the new organ, the doctor said.
Teran-Richter’s operation catapults UMC onto a short list of facilities nationwide with the capability to perform intestine transplants. Just five hospitals, including UMC, perform the procedure, according to Gruessner.
In 2008, just 55 intestine-only transplants took place in the U.S., according to the Scientific Registry of Transplant Recipients. More than 200 remain on a national waiting list for the operation.
Teran-Richter and her sister “are playing around” with the idea of starting a foundation to encourage live-donor transplants, which doctors suggest increase survival rates in organ-recipients.
Gazing into her little sister’s eyes, Teran forced back the tears. “She’s the strongest person I know. She must have 25 lives.”
Teran-Richter survived breast cancer in 2008. Just nine days after her surgery, Teran-Richter on Friday talked of returning to her job as a records manager for the town of Sahuarita.
Her doctors smiled. Her recovery may take a little longer.
“Four weeks, you watch,” she promised.