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Transplantation of multiple abdominal viscera
1Department of Surgery, School of Pharmacy, University of Pittsburgh Health Center, University of Pittsburgh, Pa.
JAMA
|March 10, 1989
Summary
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.