En bloc combined reduced-liver and small bowel transplants - From large donors to small children

被引:59
作者
de Ville de Goyet, J
Mitchell, A
Mayer, AD
Beath, SV
McKiernan, PJ
Kelly, DA
Mirza, D
Buckles, JAC
机构
[1] Birmingham Childrens Hosp, Liver Unit, Birmingham B4 6NH, W Midlands, England
[2] Queen Elizabeth Hosp, Liver Unit, Birmingham B15 2TH, W Midlands, England
关键词
D O I
10.1097/00007890-200002270-00016
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background. The critical shortage of size-matched donor organs for infants and small children in need of combined liver and intestinal transplantation has lead to long waiting times and a high risk of dying before transplantation. Utilizing grafts from larger donors could alleviate this problem, but using larger composite grafts in small children has been challenging and unsuccessful in the past. Methods. We conducted a pilot study for evaluating the results of transplanting into small recipients a composite graft (reduced-size liver and whole small bowel, including duodenum and pancreas head) procured from large donors. Liver size reduction was performed ex situ using the extrahilar approach, which leaves the liver hilum untouched. Straightforward implantation of the graft was performed by simple, two-step vascular anastomoses. The preservation of the donor duodenum in continuity with the combined graft avoided the need for biliary reconstruction, thus preserving maximal bowel length for gut continuity restoration in the recipient. Results. Two children, weighing 7.6 and 9.8 kg, respectively, underwent transplantation of a composite graft procured from donors weighing 35 kg, Their waiting time (68 and 97 days, respectively) was shorter compared with our previous experience with conventional techniques. Both are currently alive and well, at home and on full enteral feeds, 15 and 11 months after transplantation, respectively. Conclusion. This new technique has extended the range of possible donors for small candidates waiting for combined grafts and was successful in two patients. It should be considered for small recipients in the future.
引用
收藏
页码:555 / 559
页数:5
相关论文
共 15 条
[1]  
Boudjema K, 1991, Chirurgie, V117, P860
[2]   Factors impacting the survival of children with intestinal failure referred for intestinal transplantation [J].
Bueno, J ;
Ohwada, S ;
Kocoshis, S ;
Mazariegos, GV ;
Dvorchik, I ;
Sigurdsson, L ;
Di Lorenzo, C ;
Abu-Elmagd, K ;
Reyes, J .
JOURNAL OF PEDIATRIC SURGERY, 1999, 34 (01) :27-32
[3]   LOGISTICS AND TECHNIQUE FOR COMBINED HEPATIC INTESTINAL RETRIEVAL [J].
CASAVILLA, A ;
SELBY, R ;
ABUELMAGD, K ;
TZAKIS, A ;
TODO, S ;
REYES, J ;
FUNG, J ;
STARZL, TE .
ANNALS OF SURGERY, 1992, 216 (05) :605-609
[4]  
de Goyet JD, 1998, TRANSPLANT INT, V11, P117
[5]   IMPACT OF INNOVATIVE TECHNIQUES ON THE WAITING LIST AND RESULTS IN PEDIATRIC LIVER-TRANSPLANTATION [J].
DEGOYET, JD ;
HAUSLEITHNER, V ;
REDING, R ;
LERUT, J ;
JANSSEN, M ;
OTTE, JB .
TRANSPLANTATION, 1993, 56 (05) :1130-1136
[6]  
EMOND JC, 1993, SURG GYNECOL OBSTET, V176, P11
[7]  
Kiyozaki Hirokazu, 1996, Journal of Parenteral and Enteral Nutrition, V20, P67, DOI 10.1177/014860719602000167
[8]   Is the graft too big or too small? Technical variations to overcome size incongruity in visceral organ transplantation [J].
Nery, JR ;
Weppler, D ;
DeFaria, W ;
Liu, P ;
Romero, R ;
Tzakis, AG .
TRANSPLANTATION PROCEEDINGS, 1998, 30 (06) :2640-2641
[9]  
Rahman MS, 1996, TRANSPLANT P, V28, P2551
[10]   Reduced-size orthotopic composite liver-intestinal allograft [J].
Reyes, J ;
Fishbein, T ;
Bueno, J ;
Mazariegos, G ;
Abu-Elmagd, K .
TRANSPLANTATION, 1998, 66 (04) :489-492