When Hajara Paiker, a homemaker from Kabul, got a stomachache seven months ago, little did she realize that it would become life threatening.
Paiker (27) underwent removal of small intestine for gangrene while she was five months pregnant. Later, she was diagnosed with short bowel syndrome, which typically occurs in people who have no intestine to absorb fluid. It leads to poor absorption of nutrients, resulting in weakness and comorbidities in the long run. An inherited condition of blood clotting made matters worse.
It was not possible to conduct small bowel transplant in Kabul, and Paiker was dependent on total parental nutrition (TPN) for survival. “We were disappointed and had lost all hopes after the doctors informed that my wife had minimal chances of survival,’’ said Gulam, her husband.
The couple searched for treatment options and came to know about small intestine transplant. Gulam found out that the surgery is done at Fortis Hospital in Bengaluru.
The couple had to overcome several hurdles as they prepared for the transplant.
Organ procurement and transplant during the pandemic is challenging. “Identifying the donor itself was a challenge,’’ recalls Dr. Mahesh Gopashetty, senior consultant, Hepato-Pancreato-Biliary and Liver Transplant Surgery, Fortis Hospital in Bengaluru. “We had a donor, but she fell ill and we missed on a couple of opportunities. After a waiting period of three months, we found another donor (who was brain dead). The transplant was performed immediately after the availability of the organ”.
Paiker underwent the transplant a few days ago and is now able to have food and drink normally.
Small intestinal transplant is a complicated operation, explains Gopashetty. “When you do a heart, liver or a kidney transplant, the organ interacts with the person's immune system. the immune system is the one which fights infections and recognises the self from the non-self. When you put an organ from another person, the body recognises that organ as something foreign and there is always going to be some kind of a fight that goes on. And that is why they need some medicines to get the balance correct.’’
When it comes to small intestinal and lung transplants, they not only interact with our immune system, but also with our environment. “For example, intestine interacts with the food and the toxins that we eat, the lung interacts with the air that we breathe. When there is a problem, like infection or rejection, both of them perform very similarly. The challenge is in identifying whether it is an infection or a rejection, because the treatment of infection is reduction of immune suppression medications whereas rejection requires increasing the immune suppression.’’
If you don't get the balance right, the consequences can be fatal, he said. “And again, when there is rejection, the patient tends to be presented with infection because there is some kind of barrier in a normal person which prevents these infections from getting into the bloodstream. In the setting of transplant, when there is rejection, the barrier is lost. So, it becomes very imperative to differentiate between the two and find out whether they are presenting together or not.’’
Paiker had a tendency to form blood clots and this risk was the highest after the transplant surgery. She was administered blood thinners to prevent clots, which resulted in bleeding. In order to stop the bleeding, another surgery was performed on her.
Paiker is hale and hearty now, and Gulam is immensely thankful. “I can’t thank the donor’s family enough. They have given my wife a new lease of life,’’ he said.