Living Donor Intestinal Transplantation: Evolution and Results

Intestinal transplantation treats short bowel syndrome. Living donor (LD) versus deceased donor (DD) transplants offer shorter ischemia time, better human leukocyte antigen matching, reduced waiting-list mortality, and (preventive) transplantation before liver disease. A standardized procurement and technique made LD transplantation reproducible and safe. About 200 cm of donor distal ileum (100 cm in children) is removed on an ileocolic or superior mesenteric artery and vein pedicle. Graft vessels connect to recipient systemic vessels; ileostomy allows biopsy access. Donor deaths are unreported; excellent graft function and TPN-independence are common; LD vs DD outcomes are at least comparable.