Splanchnic transplantation. An approach to the infant dependent on parenteral nutrition who develops irreversible liver disease.
Two infants with short-bowel syndrome and liver failure associated with obligatory parenteral nutrition received a composite allograft that consisted of en bloc liver, stomach, duodenum, pancreas, jejunum, and ileum. Solutions to the fatal complications in the first case resulted in a functioning composite splanchnic system in the second case. Despite a number of early complications, the small intestine and liver developed near-normal function until a monoclonal, malignant, B-cell lymphoproliferative disorder appeared. The analysis of these two cases supports three summary observations: the operative procedure can be safely performed in a metabolically compromised infant; intestinal allograft rejection, in this model, is controllable with existing immunosuppressive drugs; and this procedure appears to be associated with a uniquely high incidence of lymphoma. Since transplantation is a feasible solution to this devastating infantile disease, further development of this therapy must incorporate means of preventing lymphoma.
Williams
J W
JW
Department of General Surgery, Rush-Presbyterian-St Luke's Medical Center, Chicago, Ill 60612.
Sankary
H N
HN
Foster
P F
PF
Loew
J M
JM
Goldman
G M
GM
Lowe
J
J
D003524:Cyclosporins / Q000008:administration & dosage / Q000493:pharmacokinetics; D004854:Herpesvirus 4, Human; D006801:Humans; D007223:Infant; D008107:Liver Diseases / Q000209:etiology / Q000601:surgery*; D008232:Lymphoproliferative Disorders / Q000276:immunology* / Q000473:pathology; D008297:Male; D010288:Parenteral Nutrition; D011183:Postoperative Complications / Q000473:pathology; D012778:Short Bowel Syndrome / Q000209:etiology / Q000601:surgery; D014781:Viscera / Q000637:transplantation*
D003524:Cyclosporins