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Serious Medicine. Extraordinary Care.

Clinical Trial Holds Hope and Potential for Pediatric Organ Transplant Patients

The new study is among the largest of its kind in the world

It is a medical Catch-22; the nutritional supplement necessary to keep children with failing intestines alive can also damage another vital organ.

“Children with short intestines have a very difficult time absorbing sufficient nutrition by mouth to survive and grow,” explained David Mercer, MD, PhD, director of the Intestinal Rehabilitation Program at The Nebraska Medical Center and assistant professor of Surgery at The University of Nebraska Medical Center. “In order to get sufficient calories to grow, they require intravenous feeding called total parenteral nutrition (TPN).”

The calorie-dense lipids in TPN help keep the intestinal failure patients alive, but the type used in the United States contain a high amount of Omega-6 fatty acids which can lead to cirrhosis of the liver.

“The cirrhosis can develop very quickly in children; often in as little as three to six months,” said Dr. Mercer. “Without a major medical intervention or a transplant, these children die.”

Dr. Mercer is hopeful about a new clinical trial which just began at The Nebraska Medical Center. Omegaven, a lipid preparation made from fish oil could be far less toxic to patients’ livers than TPN.

“It may even reverse damage done to the liver by other kinds of lipids,” Dr. Mercer said.

Seven-month-old Braxton Anderson of Alda, Neb. is lucky; TPN has been his sole source of nutrition since birth.

“His liver is OK for now,” said Braxton’s mother, Cassie Hendrickson. “But we’re really looking forward to the start of the Omegaven trial. Anything to save his liver.”

Born with gastroschisis, an intestinal defect, Braxton lost the majority of his small intestine right after he was born.

“He only has 47 centimeters of small intestine,” said Hendrickson. “He doesn’t know how to eat by mouth, he’s been fed by his TPN line his whole life.”

“Even so, he seems like a normal baby.” commented TR Anderson, Braxton’s father.

“He loves to watch people and he always smiles when we put on country music.”

His parents hope the medical center’s Intestinal Rehabilitation Program can help Braxton lead a more normal life while minimizing the need for more surgery. Part of that is Omegaven. With it, Braxton may be able to receive his nutrition without damaging his liver, all while doctors work to repair his intestines.

The study in Omaha is among the largest of its kind in the world.

Omegaven is only currently available in Europe, except in the case of studies like the one in Omaha or under special release from the FDA. Where TPN lipids are made from dense soybean lipids, Omegaven is made from fish oil.

“Fish oil is all Omega-3 fatty acids,” explained Dr. Mercer. “These are the lipids we always hear about being ‘heart healthy.’”

Medical center patients are receiving it as part of the trial and are under the close watch and care of doctors and nurses in the Intestinal Rehabilitation Program.

Even though Braxton still faces serious and complicated medical issues, his parents feel lucky to be receiving world-class care just a few hours from home.

“We didn’t know the intestinal rehab program existed,” said Hendrickson. “But we’re glad we found it.”

The Nebraska Medical Center’s pediatric intestinal failure program is the busiest in the world. The intestinal transplant program is the largest in the United States.

“That experience allows us to comprehensively treat patients like Braxton,” Dr. Mercer said. “It’s why this trial is so important; we can now enroll patients in this study which will allow them to have access to Omegaven in a controlled setting with comprehensive medical and surgical care of their intestinal failure.”