(I first heard about gut transplants when I was interviewing Michael Zasloff of Georgetown University for a different piece. The idea that you can transplant someone’s entire intestines blew my mind. None of the Nature editors had ever heard of it, either. The implications–that you can study how bacteria colonize a gut after birth–really make this story compelling. And yes, I got to see some gruesome stuff. I’ll never quite forget the startlingly yellow poop Stuart Kaufman raved about. You can download a pdf of this article.)
The human body teems with microbes. Apoorva Mandavilli meets the surgeons who have a rare opportunity to watch an ecosystem being established as they transplant guts from one person to another.
Stephanie is the first to admit that she never had the guts for life. She was born with familial adenomatous polyposis, a genetic disorder in which thousands of polyps form in the colon. By the age of 22, much of the organ had to be removed. Four years later, a massive benign tumour choked off the blood supply to her small intestine, so doctors cut out all but a metre of it. For the next six years, she was fed by a tube every night until the feeding left her liver badly scarred and fighting recurring infections. “I was given a month to live,” she says.
That’s when doctors referred Stephanie to Georgetown University Hospital in Washington DC. There, on 17 April 2006, surgeons cut out her stomach and what was left of her small and large intestine and replaced it with new organs from a donor who had died days earlier in Tennessee. “Oesophagus to anus, her entire gastrointestinal tract was in the garbage can,” says Tom Fishbein, who directed the surgery. “She got a brand new one.”
All organ transplants are complicated, but there are only a handful of centres in the United States that have the expertise to transplant a small intestine, the seven metres of coiled tissue connected up to the stomach at one end and the large intestine at the other. The technique is complicated because the gut is teeming with trillions of bacteria and other microbes, plus the bulk of the body’s lymphocytes.