Living related segmental bowel transplantation: from experimental to standardized procedure.
BACKGROUND
Living donor bowel transplantation has recently emerged as a valuable alternative to cadaver bowel transplant. We herein present our single-center experience with this procedure.


METHODS
From April 1998 to October 2004, 12 living donor intestinal transplants were performed in 11 patients (7 males, 4 females; average age, 26 years). Four of the patients were children under 5 years. A segment of distal ileum 150 to 180 cm long in pediatric recipients and 200 cm long in adult was used. The immunosuppressive protocol consisted of induction with thymoglobulin and maintenance with tacrolimus with or without mycophenolate mofetil and steroids.


RESULTS
All donors recovered well and did not experience any early or late complications. The overall 1- and 3-year patient survival was 82% with a graft survival of 75%. In the last 8 patients, transplanted after January 2000, the 1-year patient and graft survival has been 100% and 88%, respectively. The median hospital stay was 36 days (range, 13-290 days). During the first year after transplant only, the patient who received a totally mismatched graft experienced one episode of rejection (8%). All the surviving patients are currently supported by enteral diet without fluid requirements.


CONCLUSIONS
Living donor bowel transplantation is a valuable strategy in the treatment of irreversible intestinal failure. The results have improved over the years thanks to increased experience of the team.
Benedetti
Enrico
E
Division of Transplantation, University of Illinois at Chicago, Chicago, IL 60612, USA. Enrico@uic.edu
Holterman
Mark
M
Asolati
Massimo
M
Di Domenico
Stefano
S
Oberholzer
José
J
Sankary
Howard
H
Abcarian
Herand
H
Testa
Giuliano
G
D000328:Adult; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007082:Ileum / Q000637:transplantation*; D007223:Infant; D007410:Intestinal Diseases / Q000401:mortality / Q000601:surgery*; D019520:Living Donors; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome