Reduced-size orthotopic composite liver-intestinal allograft.
A composite graft consisting of a reduced left lateral hepatic segment in continuity with the small intestine was procured from an adult cadaveric donor using a modified in situ split technique. The primary recipient was a 3-year-old boy with hepatointestinal failure. The right side of the liver was transplanted into a 63-year-old man with a central hepatoma and hepatitis C cirrhosis. This was accomplished with center-to-center sharing of the liver portion of the allograft. The in situ split technique was feasible, with good initial allograft function. However, both grafts failed subsequently because of peri-operative recipient-related complications. The adult patient died of an infected pseudoaneurysm of the arterial graft, and the pediatric patient required repeat transplantation as a result of the late diagnosis of a native pancreatic fistula with cholestatic damage to the reduced liver allograft. The child is currently alive 8 months after repeat transplantation.
Reyes
J
J
Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh Intestinal Care Center, Pennsylvania 15213, USA.
Fishbein
T
T
Bueno
J
J
Mazariegos
G
G
Abu-Elmagd
K
K
D006801:Humans; D007223:Infant; D007421:Intestine, Small / Q000637:transplantation*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000379:methods