Addressing extreme size mismatch in pediatric intestinal transplantation: Outcomes of intestinal length reduction
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Updated: Jul 26, 2025
Small Bowel Transplantation In Mice
Published on: August 20, 2007
Angus Hann1,2,3, Girish L Gupte1, Adithya Pathanki1,2
1Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.
Insights
Intestinal length reduction (LR) is a safe and effective strategy for pediatric intestinal transplantation, especially when donor size is limited. This technique ensures comparable survival rates to full-length grafts in small children.
Area of Science:
- Pediatric surgery
- Transplantation immunology
- Gastroenterology
Background:
- Intestinal transplantation is crucial for children with short bowel syndrome.
- Limited availability of size-matched donors necessitates graft modification strategies.
- Bench liver reduction with intestinal length reduction (LR) is employed for small pediatric recipients.
Purpose of the Study:
- To evaluate the short, medium, and long-term outcomes of intestinal graft reduction in pediatric patients.
- To compare outcomes between intestinal grafts with length reduction (LR) and full-length (FL) grafts.
Main Methods:
- A retrospective analysis of 105 pediatric intestinal transplant recipients from April 1993 to December 2020.
- Patients were categorized into two groups: those receiving LR grafts and those receiving FL grafts.
- Outcomes assessed included graft and patient survival, and abdominal closure complications.
Main Results:
- The LR group (n=10) consisted of younger and smaller children compared to the FL group (n=95).
- Similar abdominal closure rates and low incidence of abdominal compartment syndrome were observed in both groups.
- 90-day, 1-year, and 5-year graft and patient survival rates were comparable between the LR and FL groups.
Conclusions:
- Intestinal length reduction (LR) is a safe and viable strategy for infants and small children undergoing intestinal transplantation.
- This technique is particularly beneficial when there is a significant size mismatch between the donor graft and the recipient.
- LR should be considered to optimize outcomes in pediatric intestinal transplantation programs facing donor size limitations.
Background:
Bench liver reduction, with or without intestinal length reduction (LR) (coupled with delayed closure and abdominal wall prostheses), has been a strategy adopted by our program for small children due to the limited availability of size-matched donors. This report describes the short, medium, and long-term outcomes of this graft reduction strategy.
Methods:
A single-center, retrospective analysis of children that underwent intestinal transplantation (April 1993 to December 2020) was performed. Patients were grouped according to whether they received an intestinal graft of full length (FL) or following LR.
Results:
Overall, 105 intestinal transplants were performed. The LR group (n = 10) was younger (14.5 months vs. 40.0 months, p = .012) and smaller (8.7 kg vs. 13.0 kg, p = .032) compared to the FL group (n = 95). Similar abdominal closure rates were achieved after LR, without any increase in abdominal compartment syndrome (1/10 vs. 7/95, p = .806). The 90-day graft and patient survival were similar (9/10, 90% vs. 83/95, 86%; p = .810). Medium and long-term graft survival at 1 year (8/10, 80% vs. 65/90, 71%; p = .599), and 5 years (5/10, 50% vs. 42/84, 50%; p = 1.00) was similar.
Conclusion:
LR of intestinal grafts appears to be a safe strategy for infants and small children requiring intestinal transplantation. This technique should be considered in the situation of significant size mismatch of intestine containing grafts.
