Combined living donor liver/small bowel transplantation.
We are reporting the first known case of sequential combined living donor liver/small bowel transplantation (LDL/SBT). A 2-year-old boy born with gastroschisis and intestinal malrotation lost his entire small bowel and colon shortly after birth. He underwent a living donor small bowel transplant at 1 year of age that was lost 4 months after implantation for posttransplant lymphoproliferative disease (PTLD). He recovered from PTLD but developed total parenteral nutrition (TPN)-induced liver failure. He received a combined left lateral liver and terminal ileum transplant that we chose to perform sequentially due to the presence of preformed antibodies against his mother's tissues. The mother had no complications and a cumulative hospital stay of 7 days. At 9 months postsurgery, the patient is on full enteral nutrition and has suffered neither technical complications nor rejection. The technique described here is reproducible and makes combined living donor LDL/SBT an alternative to combined cadaveric liver-small bowel transplant.
Testa
Giuliano
G
Department of Surgery, Division of Transplantation, University of Illinois at Chicago, Chicago, Illinois 60612, USA. gtesta@uic.edu
Holterman
Mark
M
John
Eunice
E
Kecskes
Susan
S
Abcarian
Herand
H
Benedetti
Enrico
E
D002675:Child, Preschool; D006801:Humans; D007082:Ileum / Q000637:transplantation*; D008103:Liver Cirrhosis / Q000209:etiology / Q000601:surgery; D017093:Liver Failure / Q000150:complications / Q000209:etiology; D016031:Liver Transplantation / Q000379:methods; D019520:Living Donors; D008232:Lymphoproliferative Disorders / Q000209:etiology; D008297:Male; D016377:Organ Transplantation / Q000379:methods; D010289:Parenteral Nutrition, Total / Q000009:adverse effects; D012086:Reoperation; D016896:Treatment Outcome