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Transplantation of multiple abdominal viscera
1Department of Surgery, School of Pharmacy, University of Pittsburgh Health Center, University of Pittsburgh, Pa.
Insights
Multi-organ transplants involving the stomach, intestines, colon, pancreas, and liver offer potential for patients with short-gut syndrome and liver failure. One patient survived over six months, showing no graft rejection.
Area of Science:
- Gastroenterology and Hepatology
- Transplant Surgery
- Pediatric Surgery
Background:
- Short-gut syndrome and secondary liver failure present significant challenges in pediatric patients.
- Current treatment options are limited, often leading to poor prognoses.
Observation:
- Two pediatric patients with short-gut syndrome and liver failure underwent en bloc transplantation of the stomach, small intestine, colon, pancreas, and liver.
- The first patient experienced perioperative mortality.
- The second patient survived for over six months.
Findings:
- The long-surviving patient demonstrated excellent graft function and morphological integrity for 193 days.
- No evidence of graft rejection or graft-versus-host disease was observed in the surviving child.
- The patient ultimately succumbed to an Epstein-Barr virus-associated lymphoproliferative disorder causing biliary obstruction and sepsis.
Implications:
- En bloc multi-organ transplantation is a viable, albeit complex, option for select pediatric cases of short-gut syndrome with liver failure.
- The absence of rejection in the long-term survivor suggests potential for successful immunomodulation in such complex transplants.
- Further research is needed to address non-graft-related complications, such as viral-associated disorders, post-transplantation.
Abstract:
Two children with the short-gut syndrome and secondary liver failure were treated with evisceration and transplantation en bloc of the stomach, small intestine, colon, pancreas, and liver. The first patient died perioperatively, but the second lived for more than 6 months before dying of an Epstein-Barr virus-associated lymphoproliferative disorder that caused biliary obstruction and lethal sepsis. There was never evidence of graft rejection or of graft-vs-host disease in the long-surviving child. The constituent organs of the homograft functioned and maintained their morphological integrity throughout the 193 days of survival.