8-year-old Portland boy gets rare intestine transplant at Children's Hospital
His name is Alfie Bautista. He's an 8-year-old Portland boy with a huge smile, who loves music and reading. And for his entire life, he...
Seattle Times medical reporter
His name is Alfie Bautista. He's an 8-year-old Portland boy with a huge smile, who loves music and reading. And for his entire life, he has needed to be fed through an intravenous line just to survive, because he was born with intestines that didn't work.
This week at Children's Hospital & Regional Medical Center in Seattle, Alfie received an intestine transplant — the complete replacement of his small intestine — that will enable him to finally eat solid food.
The seven-hour procedure Thursday marked the first time such a transplant has been done in the Northwest. And Alfie was recovering well late Friday.
"It went very smoothly," said Dr. Jorge Reyes, who led the surgery.
Only about 150 intestine transplants a year are performed in the U.S., compared with nearly 22,000 other solid-organ transplants, such as hearts, kidneys and livers. Intestine transplants were first performed in the late 1980s, but only in the past several years have they increased to more than 100 a year as the technology improved. Still, only five medical centers in the nation perform more than a few of them each year.
The survival rate has improved recently because of advancements in the prevention of organ rejection. An improved anti-rejection drug is used, and many patients start receiving antibodies even before the surgery to keep immune cells from attacking the new organ.
Now about 65 percent of recipients nationwide survive for three years after the transplant, according to the United Network for Organ Sharing. Ninety percent survive at least three years if the procedure is done by an experienced expert.
Alfie was in good hands. Reyes performed about 200 of the operations before he came to Children's 2 ½ years ago.
Alfie was born with a condition in which his intestines were unable to push food through his body as normal bowels do. Though he has been kept alive with intravenous feedings, the transplant became urgent because his veins were getting too damaged to continue inserting feeding lines into them.
The new intestine came from a child donor whose identity was not revealed for privacy reasons.
Even after the procedure, Alfie will need a portal that has been cut into his small intestine — an operation called an ileostomy — to allow digested food to be excreted. His large intestine does not function, and transplants for that portion of the bowel have not been attempted.
Still, Alfie was overjoyed with the prospect of eating real food. Before the surgery, even an occasional Popsicle caused him to have painful gas, or even to throw up. Anything solid could have caused a dangerous bowel obstruction.
"I'll be able to have lollipops and after that, beefsteak!" he said, clutching his blue teddy bear. "Then after that, Popsicles and ice cream!"
A 10-person team, including three surgeons, performed the operation. For hours, they cut away scar tissue from Alfie's bowel, which had endured years of inflammation and other operations.
"We have to see where we want to go [in the abdominal cavity], but at the same time we have all these adhesions [scarring]," said Dr. Patrick Healey, a veteran transplant surgeon, as he burned away the tissue with a Bovie, a pointed electrical instrument.
After the 7-yard intestine was finally cut away at 6:20 p.m., about three hours into the operation, surgeons worked intensely to isolate the key mesenteric artery and vein, so they could easily be connected to the donor organ.
Soon, they pulled the organ from a dripping, iced bag filled with a special preservative. Reyes and Healey irrigated it, then carried it quickly to Alfie's open abdominal cavity where the tied-off artery and vein pulsed with every heartbeat.
Working quickly and silently, the three surgeons connected the vessels, removed the clamps and then watched. The new intestine turned from beige to bright pink.
Team members talked excitedly. The organ could have survived without blood circulation for only six hours.
"Unclamping an intestine is so cool! The pressure is off!" Reyes said.
But there were still nearly two hours left. The doctors had to connect the intestine to the rest of the digestive tract.
Finally, Alfie was closed up and wheeled to intensive care.
An "A" for attitude
Alfie, a second-grader, is small for his age. Some kids tease him about that, and about how he doesn't run very fast. He has to be careful when roughhousing with his 2-year-old brother and 15-month-old sister.
And every night, he has had 10 hours of intravenous feeding.
"We hope he will have a much happier life now," said his mother, Abie Bautista. She's a homemaker. His father, Sam, works at a chain-saw-assembly plant.
Alfie will remain in intensive care for about a week, then another three weeks in the hospital. Over the first five days, he will still have his food delivered intravenously, then he can have formula. After some time, he probably will be able to eat normally, with limits on sugar and dairy products, said Dr. Simon Horslen, a gastroenterologist and transplant specialist who has treated the boy and worked closely with the surgical team.
But Alfie is a veteran of the medical system, and so everyone expects him to endure his recovery in the same way he has dealt with other challenges.
"He's so friendly, and people at the hospital aren't scary to him," said his mother. "He loves books about his body. He can explain to you all about how food goes through his body."
Abie Bautista also knows that another family paid a heavy price for Alfie's second chance.
"They lost a child," she said, her eyes welling with tears. She and her husband hope to some day meet the organ donor's family and thank them.
"It made a big difference for our son," she said.
Warren King: 206-464-2247 or firstname.lastname@example.org
Sam and Sara Lucchese create handmade pasta out of their kitchen-garage adjacent to their Ballard home. Here, they illustrate the final steps in making pappardelle pasta.