title: Simultaneous or sequential combined living donor-intestine transplantation in children.
abstract: BACKGROUND
  Since the report of the first successful living donor combined liver-intestine transplant in pediatric patients, three other cases have been performed. In this article, we describe surgical technique, outcome, and propose a broader application of this procedure using deceased donors.
  
  
  METHODS
  Four children of mean age 15.5 months (11-24 months) and weight 9.5 kg (8-10.9 kg) affected by end-stage liver and intestinal failure underwent living donor combined liver-intestine transplant with a left lateral liver and a distal segment of jejunum. In one case, the organs were transplanted simultaneously and in three in staged procedures. In all cases the liver transplant was performed first. The intestine was always transplanted with systemic venous drainage. The biliary anastomosis was a duct-to-duct, a biliodigestive, or a combined one according to the biliary anatomy of the liver graft. The abdomen was routinely closed with a Vicryl mesh followed by a skin graft. A loop graft ileostomy was fashioned for protocol biopsies and taken down within 3 months.
  
  
  RESULTS
  One intestine was lost to generalized ischemia. The child was promptly retransplanted with another living donor graft. All children are alive and well at an average follow-up of 30 months (18-54 months).
  
  
  CONCLUSIONS
  Living donor combined liver-intestine transplant can be performed successfully with excellent early outcome. The in situ splitting technique here described can be applied to obtain grafts for small children from appropriate adult deceased donors.
authors.affiliation: Department of Surgery, University of Chicago Hospitals, Chicago, Illinois 60637, USA. gtesta@surgery.bsd.uchicago.edu
authors.forename: Giuliano
authors.initials: G
authors.lastname: Testa
authors.forename: Mark
authors.initials: M
authors.lastname: Holterman
authors.forename: Herand
authors.initials: H
authors.lastname: Abcarian
authors.forename: Ronak
authors.initials: R
authors.lastname: Iqbal
authors.forename: Enrico
authors.initials: E
authors.lastname: Benedetti
mesh_terms: D001827:Body Height; D001835:Body Weight; D002675:Child, Preschool; D005260:Female; D020139:Gastroschisis / Q000601:surgery; D006801:Humans; D007223:Infant; D007422:Intestines / Q000637:transplantation*; D016031:Liver Transplantation; D019520:Living Donors / Q000706:statistics & numerical data*; D008297:Male; D013277:Stomach Volvulus / Q000601:surgery; D016896:Treatment Outcome