Multivisceral transplantation using a 2.9 kg neonatal donor.
Prematurity and very low birthweight have often been considered relative contraindications to neonatal organ donation. Organ procurement from neonatal donors is further complicated by unclear guidelines regarding neonatal brain death. We report a successful case of multivisceral transplantation using a graft from a 10-day-old, 2.9 kg, neonatal donor born at 36 6/7 wk in a 3.2 kg, three month old with intestinal and liver failure secondary to midgut volvulus. There was immediate liver graft function with correction of recipient coagulopathy, but delayed normalization of laboratory values and delayed return of bowel function. At six-yr post-transplant follow-up, the patient has normal intestine and liver function. Her last histologically confirmed rejection episode was 30 months prior to last follow-up. This case suggests that multivisceral grafts from very young or small neonatal donors may be transplanted successfully in selected cases. We propose a re-examination of the brain death guidelines for premature and young infants to potentially increase the availability of organs for infant recipients.
Department of Surgery, Children's Hospital Boston, Boston, MA 02115, USA.
R P
RP
Cauley
M Y
MY
Suh
D S
DS
Kamin
C W
CW
Lillehei
R L
RL
Jenkins
M M
MM
Jonas
K
K
Vakili
H B
HB
Kim
D001706:Biopsy; D001926:Brain Death; D005260:Female; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology; D007223:Infant; D007231:Infant, Newborn; D007410:Intestinal Diseases / Q000628:therapy; D007421:Intestine, Small / Q000503:physiopathology / Q000637:transplantation; D017093:Liver Failure / Q000628:therapy; D016031:Liver Transplantation / Q000379:methods*; D016377:Organ Transplantation / Q000379:methods; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D014184:Transplantation, Homologous / Q000379:methods; D016896:Treatment Outcome
D007166:Immunosuppressive Agents