Logistics and technique for combined hepatic-intestinal retrieval

Area of Science:

• Transplantation surgery
• Gastroenterology
• Organ procurement

Background:

• Pediatric and adult organ transplantation present unique challenges.
• En bloc liver-small bowel grafts offer a potential solution for complex cases.
• Maintaining intestinal barrier integrity post-transplant is crucial for patient outcomes.

Purpose of the Study:

• To evaluate the feasibility and outcomes of en bloc liver-small bowel cadaveric graft procurement.
• To assess the functional recovery of transplanted organs, particularly the small bowel.
• To determine the impact of this procurement technique on intestinal barrier integrity.

Main Methods:

• Procurement of en bloc liver-small bowel cadaveric grafts over a 13-month period.
• Transplantation into seven pediatric and one adult recipient.
• Monitoring of immediate graft function, patient recovery, and small bowel function.

Main Results:

• Successful procurement and transplantation of eight en bloc liver-small bowel grafts.
• Immediate function of all liver grafts.
• Successful recovery in all but one recipient patient.
• Delayed but intact recovery of absorptive small bowel function.
• Preservation of the bacterial intestinal barrier integrity.

Conclusions:

• En bloc liver-small bowel transplantation is a viable technique for select pediatric and adult patients.
• The procedure ensures immediate liver function and good overall patient recovery.
• Intestinal barrier integrity is maintained, despite slow return of absorptive function.