Christine Chapa

Photo courtesy of the Chapa family

When parents anticipate the first two years of their child's life, they think of phenomenal growth and development. Significant benchmarks include sleeping through the night, teething and the progression from rolling to crawling to full strides. They imagine those first coos, which transform to recognizable words, soon to be strung together to represent complete thoughts. For Andres Escobar Chapa, his daughter's first two years of milestones would be quite different.

Christine Chapa was born with Short Gut Syndrome. "The medical term is gastroschises, characterized by a very short small intestine with the bowel outside the baby's abdomen," says Mayo Clinic Pediatric Transplant Surgeon Michael Ishitani, M.D. "This syndrome is fairly rare, occurring in 1 out of every 10,000 births. The condition is correctable by surgically placing the bowels inside the abdomen and correcting any damage. Unfortunately, Christine's case was quite severe and she had only a fraction of the normal length of small intestine."

While Christine's initial surgery — performed shortly after her birth — went well, she did not thrive during her first year of life. Christine's flagging weight was compounded by her body's limited ability to absorb nutrition. Her health began to fail and at 16 months she experienced liver failure.

"We were informed early on that Christine might require a bowel-liver transplant," says Christine's father. "We just hoped and prayed this possibility wouldn't come to fruition."

As Christine's condition deteriorated, she was hospitalized and bumped up on the transplant list. "She was on the edge slowly bleeding to death," says Esmeralda Chapa, Christine's aunt. "Her yellow cast was ghastly and I felt so helpless. I was never able to have children of my own and Christine and I have a strong bond that can't be described or broken. I was so relieved and grateful she could be treated at Mayo Clinic."

"Normal hemoglobin levels for a child are 12. Just before her liver transplant, Christine's level was below 3," recalls Dr. Ishitani. "Indeed, she was critically ill."

"As Christine's liver failed, the ability for it to filter and clot blood was lost," says Dr. Ishitani, who explained that Christine was not a candidate for a live donor transplant since that type of transplant requires use of the recipients' small intestine to implant. Christine's congenital condition left her with no bowel to spare. "However, during the successful liver transplant, we were able to determine that Christine had just enough small intestine and would not require a bowel transplant," says Dr. Ishitani.

Shortly after the transplant, while on the heaviest doses of immunosuppressant drugs, Christine contracted the chicken pox and a lesion was detected on her new liver. "This lesion, called PTLD, is caused by a combination of immunosuppresive medication and a systemic viral infection," says Dr. Ishitani. Fortunately, Christine recovered, her dosages were adjusted and the lesion cleared.

"We waited longer for the good things and the developmental milestones," says her father. "Today, Christine is eating everything in sight, gaining weight and it takes both me and my sister to keep up with her. These are the challenges for which I've been waiting. I'm grateful for and happy to deal with them."

Mayo Clinic in Rochester performs 8 to 10 pediatric liver transplants each year. Christine Chapa's transplant operation will allow her to live a near-normal life and her prognosis is excellent.