It is a French first. Surgeons have just successfully performed a transplant of 5 digestive organs in a 26-year-old man.
“I would like a doctor steak!” These are the first words of the young patient who has just benefited from the 1time simultaneous transplantation of 5 digestive organs at Beaujon hospital in Paris. Still in intensive care this Friday, the 26-year-old young man who underwent this exceptional operation on December 17, 2012 suffered from a rare congenital disease. Myopathy of the digestive tract, which prevented him from eating normally.
Less than 500 people are affected by this pathology in France. Until then, he lived thanks to parenteral nutrition, that is to say that one had to supplement the food artificially by intravenous route. “It has been several months since he ate solid food at all, and for years he could only eat rusks or porridge,” says Prof. Yoram Bouhnik, head of the gastroenterology and assistance service. nutrient at Beaujon Hospital. Unfortunately in recent weeks, the patient’s condition has deteriorated sharply, and this multiorgan transplant has become vital for him.A 12 hour operation with 8 doctors
A week ago, the Biomedicine Agency warned the Beaujon teams that this patient is finally at the top of the list of the national graft waiting register. This Monday morning, the hospital receives a second phone call, there is a donor who is currently brain dead.All the medical teams are mobilizing. Surgeons leave 400 km from Beaujon to carry out the sample which they bring back in less than 3 hours. This is where the French premiere begins. “We carried out a very complex operation. We have removed almost all of the patient’s digestive organs, leaving only the spleen ”.
Then the liver, pancreas, stomach, duodenum and small intestine were successfully transplanted simultaneously. “Four surgeons and four intensive care anesthetists followed one another in the operating room for 12 hours,” recounts Professor Jacques Belghiti, head of the hepatobilio-pancreatic surgery department. This was possible in Beaujon, because we have a complete digestive center and we are also a reference center for rare intestinal diseases. “
This “block graft” technique was developed in the USA. In Europe, a few countries, such as Italy, have also practiced it. In France, on the other hand, this is the first time that it has been carried out in adults. In children, these “block transplants” have been developed for a few years because the risks of rejection are less important.4 days after the operation, the doctors confirm that the patient is doing well. So far, the postoperative results are going well. “The patient was extubated only 12 hours after the operation. This is a first positive point. 48 hours later he began to be fed enterally ”, which consists of administering nutrients through the digestive tract using a probe. “And I saw him this morning, he was transfigured, he even asked me for a steak. »Adds Professor Jacques Belghiti.
A patient under surveillance
Despite the undeniable technical feat, the doctors temper their enthusiasm because for several months the patient will remain under surveillance. As with any transplant, there is a particular risk of rejection, and when it comes to digestive transplantation, specialists specify that it is more important. “Even if a rejection phenomenon occurs, that does not mean that it would be necessary to de-transplant. Today, we still know how to handle these situations well, so we should intensify immunosuppressive treatments, ”explains Dr Olivier Corcos, gastroenterologist.The success of such an intervention naturally opens up encouraging prospects in the field of multi-organ transplantation in adults. “For the medium term, our objectives are that at the end of January, he will start eating solid foods again. At the end of February, we hope to be able to take away his parenteral path and finally, at the end of March, he will be able, we hope, to finally return home and lead a normal life, eat like everyone else and why not work ”, concludes with emotion Pr. Yoram Bouhnik.
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