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Simultaneous or sequential combined living donor-intestine transplantation in children
Giuliano Testa1, Mark Holterman, Herand Abcarian
1Department of Surgery, University of Chicago Hospitals, Chicago, Illinois 60637, USA. gtesta@surgery.bsd.uchicago.edu
Insights
Living donor combined liver-intestine transplants are successful in pediatric patients with end-stage organ failure. This surgical technique can be adapted for deceased donors, expanding treatment options for children needing liver and intestinal grafts.
Area of Science:
- Hepatobiliary surgery
- Pediatric transplantation
- Gastrointestinal surgery
Background:
- Combined liver-intestine transplantation is a complex procedure for end-stage organ failure.
- Few cases have been reported, primarily using living donors.
- This study details surgical techniques and outcomes for pediatric patients.
Observation:
- Four pediatric patients (mean age 15.5 months) underwent living donor combined liver-intestine transplant.
- Procedures involved left lateral liver grafts and distal jejunum segments.
- Transplants were performed simultaneously or staged, with liver transplant preceding intestine transplant.
Findings:
- All pediatric patients survived with excellent early outcomes at an average follow-up of 30 months.
- One case required retransplantation due to graft ischemia.
- Successful venous drainage and varied biliary anastomosis techniques were employed.
Implications:
- Living donor combined liver-intestine transplantation demonstrates high success rates in pediatric cases.
- In situ splitting techniques can enable the use of deceased donor grafts for small children.
- This approach broadens the potential donor pool and treatment accessibility for pediatric organ failure.
Background:
Since the report of the first successful living donor combined liver-intestine transplant in pediatric patients, three other cases have been performed. In this article, we describe surgical technique, outcome, and propose a broader application of this procedure using deceased donors.
Patients:
Four children of mean age 15.5 months (11-24 months) and weight 9.5 kg (8-10.9 kg) affected by end-stage liver and intestinal failure underwent living donor combined liver-intestine transplant with a left lateral liver and a distal segment of jejunum. In one case, the organs were transplanted simultaneously and in three in staged procedures. In all cases the liver transplant was performed first. The intestine was always transplanted with systemic venous drainage. The biliary anastomosis was a duct-to-duct, a biliodigestive, or a combined one according to the biliary anatomy of the liver graft. The abdomen was routinely closed with a Vicryl mesh followed by a skin graft. A loop graft ileostomy was fashioned for protocol biopsies and taken down within 3 months.
Results:
One intestine was lost to generalized ischemia. The child was promptly retransplanted with another living donor graft. All children are alive and well at an average follow-up of 30 months (18-54 months).
Conclusions:
Living donor combined liver-intestine transplant can be performed successfully with excellent early outcome. The in situ splitting technique here described can be applied to obtain grafts for small children from appropriate adult deceased donors.
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