Given 24 hours to live, rare transplant saved his life

At 24, Danielle Perea was newly enrolled in a master’s degree in clinical laboratory science program, living with her boyfriend in Louisiana, and generally enjoying her life – until one day a stomach ache caused her to sitting in an area hospital, where she was told she had only hours to live.

Just a few days into her program, Perea woke up with a “severe stomach ache” that she initially mistook for food poisoning, but when she went to the bathroom, she flushed out ” frothy blood,” which prompted her to go to a hospital emergency room. has not named due to pending litigation. Perea learned that a scan done by doctors showed no signs of a problem.

When her symptoms persisted, she went to another hospital where she was observed again, but no diagnosis was made. Doctors reviewed the same scan and said it was unlikely that a clot had formed due to her age and relative health. On the third day of her symptoms, Perea began vomiting blood and returned to the emergency room as her symptoms intensified.

Exploratory surgery revealed a blood clot in one of the vessels that carry blood from the small intestine, a condition called mesenteric ischemia. Surgeons tried to salvage the organs, but found too much dead tissue.

“They saw that everything was completely black, necrotic, dead,” Perea told CBS News. “They (told my boyfriend), ‘There’s no way she’s going to survive this, you need to call her parents.’ Bring in everyone who needs them, because he probably has 24 hours to live. »

Perea was admitted to hospice care, but exceeded expectations, maintaining “strong vital signs” for more than a week. Meanwhile, her mother and her boyfriend were looking for a miracle. They learned about the Cleveland Clinic’s intestinal transplant program, the largest in the country, and the program’s head, Dr. Kareem Abu-Elmagd, agreed to take on Perea’s case.

What is an intestinal transplant and why are they so rare?

An intestinal transplant involves replacing the small intestine with a new organ. According to Dr. Masato Fujiki, only 95 transplants were performed in the United States last year. director of intestinal transplantation at the Cleveland Clinic and one of the doctors who treated Perea. Eighteen of them were performed at the Cleveland Clinic, making it the largest intestinal transplant program in the country. During the same period, more than 10,000 liver transplants and more than 4,000 heart transplants were performed.

There are about 15,000 eligible organ donors each year, and few patients are eligible for intestinal transplants. This allows doctors “to be very selective to get the best organ,” Fujiki said. Ideal intestinal donors are people under 50, in good health and with stable blood pressure.

While it is not particularly difficult to find a suitable organ, intestinal transplants did not have a high success rate until recently, contributing to their rarity, Fujiki said. The intestines are a “difficult” organ to monitor, he said, and intestinal transplants have the highest rejection rate of any type of organ transplant.

The one-year graft survival rate for an intestinal transplant patient reached 82% in 2022, up from 76.2% in 2018, according to national data. That’s still lower than the graft survival rate for more common procedures like liver transplants, which have a rate of 85% to 90%, Fujiki said.

A long road to recovery

Once Perea’s family learned of the intestinal transplant program and her case was accepted at the Cleveland Clinic, she was brought to the Ohio hospital. His small intestine was almost completely resected. Her condition stabilized and, after several more procedures, she was officially added to the transplant list in spring 2019.

Before the transplant, Perea spent a year and a half living on intravenous nutrition, because without the intestines she couldn’t eat normally. The time she spent being assisted by machines forced Perea to undergo another surgery to repair the damage to her trachea before she could receive the transplant, extending the wait time. The coronavirus pandemic also complicated the process, forcing him to pass on an organ in April 2020.

Finally, in June 2020, Perea received the call she had been waiting for.

“They would just say, ‘You need to get to the clinic right away.’ That was not an option,” Perea said.

The operation lasted 10 hours, and even after the new organ was in place, Perea continued to spend time in the hospital, being readmitted for frequent fevers. In January 2021, she underwent another procedure to repair her abdominal wall and reverse her ileostomy, an incision made during the operation.

Now, four years after the surgery, she told CBS News that she’s able to live relatively normally, despite taking “about 40 pills a day.” She may need a kidney transplant in the future, due to the impact of the anti-rejection drugs on that organ, and she has annual appointments at the Cleveland Clinic to monitor the transplant, but everything has been “super normal,” so far.

“I have no restrictions. My incisions healed well. I got married in November,” Perea said. “We bought a house. Everything is fine.”

At the Cleveland Clinic, she said, “they say, ‘Just keep living your life. There’s no stopping you.'”