At 24, Danielle Perea had just started a master’s degree in clinical laboratory science. She was living in Louisiana with her boyfriend and enjoying life. Until one day, she found herself in a local hospital with abdominal pain and 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 experienced “frothy blood” that prompted her to go to the emergency room of a hospital she did not name due to an ongoing lawsuit. Perea was told that a CT scan performed by doctors showed no signs of a problem.
When her symptoms persisted, she went to another hospital where she was observed again, but still not diagnosed. Doctors looked at the same CT scan and said something like a clot was unlikely because of her age and relative health. On the third day of her symptoms, Perea began vomiting blood and returned to the emergency room again when her symptoms worsened.
Exploratory surgery revealed that there had been a blood clot in one of the blood vessels that carries blood from the small intestine, a condition called mesenteric ischemia. Surgeons tried to save the organs, but found too much necrotic tissue.
“They just saw that everything was completely black, necrotic and dead,” Perea told CBS News. “They told my friend, ‘There’s no way she’s going to survive this, you need to call her parents. Get someone who needs to be here because she probably has 24 hours to live.'”
Danielle Perea
Perea entered hospice care but exceeded expectations, maintaining “strong vital signs” for more than a week. During that time, her mother and boyfriend searched for a miracle. They heard 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 Perea’s case.
What is a bowel transplant and why are they so rare?
In an intestinal transplant, the small intestine is replaced with a new organ. According to Dr. Masato Fujiki, only 95 were performed in the United States last year. director of intestinal transplantation at Cleveland Clinic and one of the doctors who treated Perea. Eighteen of those were performed at the Cleveland Clinic, making it the largest intestinal transplant program in the country. In the same period, more than 10,000 liver transplants and more than 4,000 heart transplants took place.
There are approximately 15,000 eligible organ donors each year, and not many patients qualify for an intestinal transplant. This allows doctors to be “very selective to get the best organ,” Fujiki said. Ideal intestinal donors are people who are younger than 50 years old, are in good health and have stable blood pressure.
While it is not particularly difficult to find a suitable organ, intestinal transplants have not had a high success rate until recently, contributing to their rarity, Fujiki said. Intestines are a “difficult” organ to monitor, he said, and intestinal transplants have the highest rejection rate of all types of organ transplants.
According to national data, the one-year graft survival rate for a patient undergoing an intestinal transplant was up to 82% in 2022, up from 76.2% in 2018. That’s still below the graft survival rate for more common procedures such as liver transplants, which has a rate of 85%. have up to 90%, Fujiki said.
A comprehensive road to recovery
When Perea’s family learned about the intestinal transplant program and her case was accepted at the Cleveland Clinic, she was taken to the hospital in Ohio. Her small intestine was almost completely removed. Her condition was stabilized and after several more procedures, she was officially added to the transplant list in the spring of 2019.
Before the transplant, Perea lived on intravenous nutrition for a year and a half, as she couldn’t eat normally without the intestines. The amount of time she spent on machine support meant that Perea had to undergo another surgery to repair the damage to her trachea before she could receive the transplant, adding to the wait. The coronavirus pandemic also complicated the process, forcing her to donate an organ in April 2020.
Danielle Perea
Finally, in June 2020, Perea received the call she had been waiting for.
“They were like, ‘You have to go to the clinic right away.’ It wasn’t an option,” Perea said.
The surgery took ten hours, and even once the new organ was in place, Perea continued to spend time in the hospital, where she was readmitted due to frequent fevers. In January 2021, she underwent another procedure to repair her abdominal wall and reverse her ileostomy, an incision made during the surgery.
Now, four years after the surgery, she told CBS News that she can live a relatively normal life, although she does take “about 40 pills a day.” There is a possibility that she may need a kidney transplant in the future, due to the impact of anti-rejection drugs on that organ, and she has annual appointments at the Cleveland Clinic to monitor the transplant, but so far everything is “super normal.”
“I have no restrictions. My incisions have healed well. I got married in November,” Perea said. “We bought a house. Everything is going well.”
At the Cleveland Clinic, she said, “They say, ‘Just keep living your life. Nothing’s holding you back.'”
Danielle Perea
