The First Case of Intestinal Transplantation in the Philippines: Perspective from a Developing Country

Intestinal transplantation has been considered the last frontier of transplantation because of the high immunogenicity of the organ itself. Although it remains the least common transplant procedure performed in the United States comprising only 0.89% of total organ transplants from 1990 to 2013 (http://optn.transplant.hrsa.gov/), we have witnessed increasing number of intestinal transplant procedures over the last decade. Early attempts were hobbled by technical and immunologic complications that contributed to graft failure or death. In developing countries, because of financial constraints and lack of expertise, the procedure is rarely contemplated and the default treatment is still Total Parenteral Nutrition (TPN), despite its attendant complications such as cholestatic liver failure, infection and sepsis. Furthermore, in the Philippines, where most patients pay out-of-pocket for medical care, the cost of TPN can be prohibitive, which often traps them in a downward spiral of lost income and high health care costs. Advances in surgical techniques and better immunosuppressive drugs contributing to improved graft and patient survival rates however have rendered intestinal transplantation as a viable option for patients with intestinal failure becoming cost-effective as compared to long-term TPN. We present a case where economic challenges associated with intestinal transplants were successfully overcome through creative post-operative care founded on evidence-based concepts. This was the first instance of an isolated intestinal transplantation in the Philippines with 1-year follow up.