[Anesthesia for a pediatric multivisceral transplant]

Area of Science:

• Transplantation surgery
• Gastroenterology
• Nephrology

Background:

• A 15-year-old female presented with short bowel syndrome secondary to chronic intestinal pseudo-obstruction and kidney failure.
• She required 5 years of parenteral nutrition, leading to severe complications including sepsis, thrombosis, liver dysfunction, bone marrow failure, and malnutrition.

Observation:

• The patient underwent a 15-hour multivisceral (stomach-duodenum-jejunum-ileum-pancreas-liver) and kidney transplant.
• The surgery was complicated by hypothermia post-revascularization, requiring significant blood product and crystalloid replacement.
• Biochemical and hemodynamic parameters remained stable, despite transient hypernatremia, hyperglycemia, and lactic acidosis.

Findings:

• The anesthetic management focused on preoperative optimization for chronic parenteral nutrition complications, hypothermia prevention, electrolyte and acid-base correction, reperfusion syndrome management, and hemodynamic support.
• Successful graft revascularization and circulatory homeostasis were achieved.

Implications:

• This case highlights the feasibility of complex multivisceral and kidney transplantation in pediatric patients with short bowel syndrome and associated organ failure.
• Careful anesthetic planning and management are crucial for addressing the unique challenges and complications in such high-risk surgical cases.