3D organ printing

I do not see anything here about COLON's

www.computerworld.com/s/article/9244884/The_first_3D_printed_organ_a_liver_is_expected_in_2014?taxonomyId=128&pageNumber=3

:)

I remember this topic from a previous post - No one seems to be able to find or post anything where a colon or intestinal transplant actually results in "re-emergence" of the disease.

Actually the real reason they did not perform this type of surgery in the past was purely because of rejection/hospitalization issues - not re-emergence of disease. It's easier/safe/cheaper to just yank it out (the colon or sections of the small intestine and be done with it)

Flash forward to today they are starting to do this (bowel transplant) in ummm London (UK) I believe is the hospital. They do it for people with short bowel syndrome from Crohn's - so people that have very little bowel left due to multiple operations. I think they have an 80% success rate now and quite a few patients.

Since the patients are given immune suppressing drugs to prevent rejection this prevents recurrence... or so the theory/thought goes but no one is 100% sure if it ever would re-occur.

The reality is no one has any clue if it's an autoimmune issue or if it's bacterial/viral or anything else.

But it will be interesting to see if any of these surgeries lead to re-emergence of symptoms in the future.

OK so--

Small intestine transplants have been performed infrequently for many years for patients with short bowel, including Crohn's patients. In the Crohn's patients the new intestine DOES eventually develop active disease, but it's a huge improvement in quality of life for the intervening years.

As far as I know -- and I have searched high and low -- large intestine transplants have never been performed. When you think about all of the man hours involved in an organ transplant (harvesting, transporting, surgical teams, recovery, follow up care, etc) and facilities etc, it makes no sense to transplant an organ that can easily be lived without. Because large intestine transplants aren't performed we can't know for sure that inflammation would return in the new colon, but we have evidence that inflammation returns to new small intestine, which does not reflect favorably on the idea of colon transplants.

That was my point Ipoop. If you are going to take those megadoses of immune suppressing drugs anyway after a transplant, maybe it is really the drugs that were working and not the transplant at all. In effect you could argue that if the patient had been on those megadrugs before the transplant, maybe that by itself would have worked and they didn't really need the transplant.

Here is the most recent item I've been able to find on this topic of transplant. Still not the Colon but IBD none the less.

Small Bowel Transplantation for the Treatment of Crohn’s Disease
www.ncbi.nlm.nih.gov/pmc/articles/PMC3533214/

"The largest series that has been reported is comprised of 6 adult patients. Two of these patients developed early, persistent histologic changes that were consistent with CD, but none of the patients developed endoscopically or clinically measurable disease up to 2 years post-transplantation."

I'm still curious to find a definitive answer that say like 50% will have recurrence or something to that nature. I can't find anything in this regard.

I guess time will tell. It's an interesting article.

@ Pluot - Do you have a paper or study that says a certain percentage develop active Crohn's disease in their transplanted intestine? I'd really like to read it if so. I've been curious on this for sometime now.

LOL zucchini, I was thinking the same thing.

I use to have a good article bookmarked about why intestinal transplants don't last forever as the immune system is the cause of why the intestines get damaged (via CD) but that was years ago and I lost the bookmarked article when we got a new computer yrs ago. From what I recall it explained that for such a dangerous and expensive surgery that transplants are, the chances of the disease coming back wasn't worth the risk of the surgery and life long meds for transplant patients would be required to take even when the disease came back (and they noted that it did come back but it varied for how long it took to come back for each patient). So docs are not keen on the idea of doing intestinal transplants.

Fruitgirl: That doesn't make sense to me because we have member after member after member come on here with a post saying they took Immunemodulators or one of the many biologics at a lower dose, it didn't work that well, or at all, and were then prescribed higher doses. Sometimes the higher doses worked, sometimes they didn't. I think if most of us asked our GI's about getting a transplant they would smirk and basically say the problem is autoimmune so a transplant wouldn't work, which would lead me to believe that if transplants actually were working in some then maybe it was due to the even higher doses of immune suppressants that the patients were taking and not really the transplant itself. Just some personal observations from a lay person.

Here's a short article on some who recently had this done,

Bowel transplant let me live again:
www.theguardian.com/lifeandstyle/2012/jul/01/bowel-transplant-let-me-live-again

And here's this same persons blog about the whole experience:
beingapatient.blogspot.ca/

And still nothing that says it will come back. That is why autoimmune is still just "hypothesis". Its never been proven one way or the other.

The whole printing of organs and such is pretty cool and mind boggling. Amazing how things have progressed/changed over such a short time. Kinda Star Trek'ish type thing haha. Like printing food. Which people are doing now, but they are having trouble getting it to taste good. There was an article on this a while ago, being able to go and just print something to eat. Crazy.

judy said...
The whole organ printing thing is confusing to me. I have no question they can print the structure, but how do they print the function?

Hmm...it does seem form follows function for a colon...so does the function just come from the direction of the brain/Central nervous system? As long as the structure looks like a muscle and is created like a muscle, the brain does the directing? Interesting question

Here's another case: Recurrent Crohn's disease in transplanted bowel: http://www.ncbi.nlm.nih.gov/pubmed/9078200

There's also one patent that had a graft where there was a return of Crohn's in both the native and transplanted intestine but this time manageable via prednisone which comes from a link at the bottom of the transplant paper www.ncbi.nlm.nih.gov/pubmed/14687158

But I have never been able to find the full paper on this. It would be interesting to find out were exactly the recurrence occurred and spread from.

For people with Crohn's when they have surgery I believe they cut 3 centimeters into the visually healthy tissue on either side of the damaged tissue and then make the connection. What's baffled surgeons and GI's is that the recurrence or initial manifestation of recurrence of the disease is almost always at this very point... where they cut and made the connection and progresses upwards from here. It's interesting from an alternative or bacterial standpoint versus autoimmune.

EDIT: This same thing occurred in a UC patient that had left sided colitis or something. She opted to try and have this section cut out and her rectum attached to her right side (perfectly healthy tissue). The disease re-occurred a few months later and progressed in the same manner - from the incision and connection point upwards. So from an "autoimmune" or a "bacterial" perspective I just find this very intriguing. Since it happens in both Crohn's and UC.

Post Edited (Canada Mark) : 2/13/2014 4:17:17 PM (GMT-7)

@NCOT or Pluot - If you read this..

I have a very, very dumb question - But aside from the trouble and issues you've had - Do you feel it has negatively effected your health in any way not having your colon? - like being sick more often, or trouble getting enough nutrition/vitamins etc.

It's the one thing that really scarred me when my first GI said she felt I would ultimately end up needing surgery and to prepare myself for it. Though she was a terrible GI anyway. Anyway, my thoughts immediately went to wondering if being without a Colon would cause me to not be able to fend off infection, or get enough vitamins or minerals etc etc... not so much the impact on my lifestyle.

Just curious is all. But that was my fear back then which now I think is just very dumb. But I wanted to ask anyway.

Mark - Funnily enough, I've been thinking about that same thing lately :-/ It was something PathogenKiller said about us being our gut bacteria which set me off; not entirely sure I agree we are inseparable from our bacteria (oh that's right; you were in that thread and winding up PK about folate synthesis, but I digress... <_<), but it did make me start thinking about the possible health impacts of losing nearl all of our gut bacteria. In fact, PK even cited a study where mice deliberately engineered to be germ-free did not flourish and needed to eat a lot more calories.

I even meant to make a topic about it, but then it slipped out of my mind.

However, I don't think the results of that mice study transfers to humans: ileostomates have no trouble absorbing all the calories from their food, for example. (As I sadly can testify to.) The only absorption issue that ileostomates have is possible dehydration due to water and sodium loss; however, the small bowel learns to absorb water to an extent, and the kidneys do the rest. Unless you are ill, dehydration is not an issue without a colon.

I can only speak for me, but I felt like I was more dehydrated with severe pancolitis than with an ileostomy. My entire colon was inflamed, so everything was getting washed out, including protein. (The fancy name is protein-losing enteropathy - albumin measures that.)

Nutrient deficiency isn't an issue: virtually all your vitamins and minerals are absorbed in the small bowel.

Having an ileostomy means your cholesterol and triglycerides are likely to be low, leading to lower levels of cardiovascular disease. (This seems to be true of UCers in general in fact.) However, ileostomates are more at risk of kidney stones.

I haven't been sick any more often: in fact I haven't had a single cough or cold since surgery a year ago <_<.

The only disappointing thing is lack of energy, but I do have other lingering health issues: hypothyroidism, residual inflammation from my leftover rectum, etc. I don't think brain fog and lack of energy has anything to do with having a colectomy, to be fair.

PS: Apologies for a rambling and disjointed answer. I'm incredibly tired right now from lack of sleep the past few nights, and am going to be logging straight off after this post. However, I don't want to waste this post because it took me long enough to write: so there >_>.