Size reduction of small bowels from adult cadaveric donors to alleviate the scarcity of pediatric size-matched organs -: An anatomical and feasibility study

被引:12
作者
Delrivière, L
Muiesan, P
Marshall, M
Davenport, M
Dhawan, A
Kane, P
Karani, J
Rela, M
Heaton, N
机构
[1] Kings Coll Hosp London, Liver Transplant Surg Serv, Dept Liver Transplant Surg, London SE5 9RS, England
[2] Kings Coll Hosp London, Dept Radiol, London SE5 9RS, England
[3] Kings Coll Hosp London, Dept Pediat Surg, London SE5 9RS, England
[4] Kings Coll Hosp London, Dept Child Hlth, London SE5 9RS, England
关键词
D O I
10.1097/00007890-200004150-00031
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. Small bowel transplantation in children weighing less than 10 kg is hindered by the lack of size-matched donors. The ability to create reduced size small bowel grafts from adult cadaveric donors suitable for use in young children has been studied. Methods. Volumetric assessment of computed tomography scans were used to evaluate abdominal cavity and small bowel volumes in children. Small bowels were retrieved from adult cadaveric donors and reduced in size. Results. Computed tomography studies of the abdominal cavity showed that the mean volume available for a small bowel graft was 260 ml in children less than 5 kg (n=5) and 460 ml in children weighing 5-10 Bg (n=5). Fifteen small bowels were successfully reduced to provide an ileal graft of one meter while Beeping the whole length of the superior mesenteric artery and vein after their dissection in the proximal part of the mesentery. The mean volume of the grafts created was 270 ml in seven thin patients (body mass index [BMI] <25), 390 ml in five preobese patients (25 < BMI<30), and 490 ml in three obese patients (BMI>30). Mesenteric transillumination in thin donors allowed safe dissection and complete hemostasis. No diameter reduction was required. Technical modifications permitted the creation of two grafts, one ileal and the other jejunal from a single donor. Volumetric and surgical data show that implantation of up to two meters of ileum from a thin adult weighing up to 80 kg is feasible in children weighing less than 10 kg. Conclusion. Size reduction of adult cadaveric small bowels can provide suitable grafts for children of less than 10 Bg and could expand the potential pool of donors for these patients.
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页码:1392 / 1396
页数:5
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