For Springfield woman, transplant offers new life

WORCESTER -- Food had become useless to Cynthia Dean, her digestive system so ravaged by decades of surgery that even the most nutritious meal raced through her body too quickly to give her any sustenance. For 2 1/2 years, the 44-year-old woman had been fed through a tube in one of her veins, leaving her increasingly tired and vulnerable to dangerous infections.

Yesterday, a beaming Dean was looking forward to a plate of lasagna after becoming New England's first recipient of an intestinal transplant from a living donor. Her 21-year-old daughter gave Dean a 5-foot segment of her own small intestine in a carefully choreographed seven-hour surgery that had not even been attempted in this region for more than a decade.

"She gave me life," said Dean of her daughter, Barbara, as the two sat side by side at UMass Memorial Medical Center where the operation was performed on April 29. "That was the best [Mother's Day] present I could ever get."

The operation was also a step forward for people in the Northeast with irreversible intestine failure. Until recent years, so many intestine transplant recipients died shortly after the surgery that local hospitals stopped performing it, and patients needed to travel to Pittsburgh for a transplant -- or, more often, endure life with a feeding tube. Just 116 were performed nationwide last year, almost all of them using intestines from a deceased donor.

"Most patients . . . tend to be acutely ill and may have undergone surgery to remove sections of diseased or damaged intestine, and so the procedure is complex and delicate," explained lead surgeon Luca Cicalese, a specialist in living donor transplants who came to UMass in 2002 to set up the new intestine program.

In addition, he said, the risk of infection from intestinal transplant is unusually high because the digestive system contains so much bacteria, and patients' immune systems are more likely to reject intestines than other organs. These daunting obstacles prompted surgeons at Massachusetts General Hospital to abandon intestinal transplants after two patients died in the early 1990s.

But intestinal transplant surgery has improved considerably since then, thanks to better anti-rejection drugs and identifying transplant candidates before they've suffered multiple organ failure. More than three-quarters of intestinal transplant patients now survive a year or more after surgery, according to data from the United Network for Organ Sharing. In fact, Mass. General may soon try intestinal transplants again.

Cicalese believes that a living donor further improves the chances of success, in part because doctors can minimize the time the donated organ is outside a body by performing the removal and implantation at the same time. And in Dean's case, her daughter's blood and tissue matched hers, reducing the risk of rejection.

Yesterday, Barbara Dean brushed off the operation, saying the surgeons "took just a small, small piece [of her intestines]. I've got a lot more." Doctors released the younger Dean last week, saying she would suffer early diarrhea but no long-term harm.

"Every morning when I wake up and know that my mom's going to be part of my day, that's what keeps me going," said Barbara Dean.

The main job of the intestines -- which, if uncoiled, would stretch 30 feet in adults -- is to absorb nutrients from food as it slowly passes through. But any number of conditions, from direct injury to Crohn's disease to birth defects such as "short gut syndrome," can block the intestine outright or impair its ability to absorb nutrients. Most patients undergo numerous surgeries and other treatments before they even become candidates for intestinal transplant. Currently, there are 190 people on the national waiting list for a transplant.

The elder Dean was an ideal candidate to launch the new program because she was both healthier and younger than most people suffering from intestine failure. A victim of a genetic condition called familial polyposis, Dean suffered growths in her colon and small intestine that required about a dozen surgeries until she was left with less than 2 feet of digestive tract.

With so little remaining intestine, Dean's body couldn't hold onto food long enough to properly digest it, meaning she could eat but still starve. "When I would eat, it would go right through me in five minutes no matter what," she said.

Since the surgery, the feeding tube has come out and doctors have allowed Dean to eat foods low in fat and sugar. Over the last week, Dean's weight went from 115 to 121 pounds as the donated intestines did their job, allowing her to go home to Springfield yesterday. Once she resumes a normal diet in a few months, Dean said, she plans to invite her surgeons for a lasagna dinner.

Scott Allen can be reached by e-mail at allen@globe.com.