In spring 2018, Duke earned certification from the Centers for Medicare and Medicaid Services (CMS) for small bowel transplants. Although the Duke Small Bowel Transplant Program has accepted patients since 2009, CMS approval enables a wider range of patients to have access to the life-saving transplants. This is especially significant because Duke is the only center for small bowel transplants in its United Network for Organ Sharing region (North Carolina, South Carolina, Virginia, Kentucky, and Tennessee) and one of fewer than 20 such programs in the country.
There are even fewer programs that have received CMS approval, which requires that a center meet certain requirements regarding transplant volume and patient outcomes. Duke has performed a total of 36 small bowel transplants (adult and pediatric), with one-month and three-year survival rates on par with the national averages of the select group of centers that perform small bowel transplants.
“The approval really speaks to the expertise and experience of our team,” says Duke’s Small Bowel Transplant Program’s medical director, M. Cristina Segovia, MD. “We have a cohesive group of expert surgeons and hepatologists who have been doing these transplants as their primary focus for years.”
Historically, total parenteral nutrition (TPN) has been the primary treatment for intestinal failure. However, long-term TPN use can result in significant irreversible complications in many patients. For these patients, intestinal transplant can be a life-saving option.
The Duke program offers the full range of procedures, including isolated small bowel transplants and multi-organ transplants of the small bowel, liver, and pancreas. Whether additional organs are transplanted depends on multiple factors, Segovia explains. Patients who have been on TPN for intestinal failure long term often have liver damage and require liver transplant as well. Other times, it is simply surgically easier to transplant organs en bloc.
Segovia is excited that the approval will allow the Duke program to operate at capacity: “For the past few years, we were getting referrals from other centers, but we weren’t able to offer transplant because the patient had Medicare. That greatly limited us, so it’s exciting that we’ll now be able to serve a much larger portion of the population.”