Related Experiment Videos
En block combined reduced-liver and small bowel transplants: from large donors to small children
J de Ville de Goyet1, A Mitchell, A D Mayer
1Liver Unit, Birmingham Children's Hospital, United Kingdom.
Insights
A novel surgical technique allows for the transplantation of reduced-size composite liver and intestinal grafts from larger donors into infants. This approach significantly shortens waiting times and offers a promising solution for pediatric patients awaiting combined liver-intestinal transplants.
Area of Science:
- Pediatric Surgery
- Transplantation Immunology
- Organ Grafting
Background:
- Infants and small children face critical organ shortages for combined liver-intestinal transplants, leading to long waits and high mortality.
- Utilizing larger donor grafts is a potential solution but has historically been challenging in small pediatric recipients.
Purpose of the Study:
- To evaluate the feasibility and outcomes of transplanting reduced-size composite liver and whole small bowel grafts from larger donors into small pediatric recipients.
Main Methods:
- A pilot study involved transplanting reduced-size composite grafts (liver, small bowel, duodenum, pancreas head) from adult donors into two small pediatric patients.
- Ex situ liver size reduction using an extrahilar approach and straightforward implantation with two vascular anastomoses were employed.
- Preservation of the donor duodenum simplified biliary reconstruction and maximized bowel length for recipient gut continuity.
Main Results:
- Two pediatric patients (7.6 and 9.8 kg) received grafts from 35 kg donors, with reduced waiting times (68 and 97 days).
- Both recipients are alive and well at 15 and 11 months post-transplant, tolerating full enteral feeds.
- The technique demonstrated successful outcomes in this small pilot series.
Conclusions:
- This innovative technique expands donor options for pediatric combined liver-intestinal transplantation candidates.
- The procedure proved successful in two small recipients, offering a viable alternative to conventional methods.
- This approach warrants consideration for future pediatric transplantation cases requiring combined grafts.
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.