Living-related small bowel transplantation for three patients with short gut syndrome

Abstract

Objective: We summarized our experience of living-related small bowel transplantation and postoperative management of 3 patients with short gut syndrome.

Methods: Patient #1, an 18-year-old boy, received a 150-cm segment of distal ileum with a vascular pedicle of distal superior mesenteric artery and vein, which was donated by his father. Patient #2, a 15-year-old boy, received a 160-cm graft of distal ileum from his mother. Patient #3, a 17-year-old boy, received a 170-cm graft of distal ileum from his father. The graft artery and vein were anastomosed to the recipient infrarenal aorta and vena cava, respectively, in end-to-side fashion using 7/0 Prolene suture. Intestinal continuity was restored by anastomosis of proximal end of the graft to the recipients' own proximal jejunum, the distal end was left open as a stoma. The recipient distal gut was anastomosed to the distal end of the graft. All 3 recipients were given FK506 (tacrolimus) regularly combined with periodic mycophenolate mofetil. In cases of acute rejection, large doses of steroids were administered to the recipients.

Results: The recipients and donors had fairly unremarkable postoperative courses. So far, patient #1 has survived for 7 years and 6 months with a well-functioning graft and without requirement for total parenteral nutrition (TPN) support. His body weight increased 20 kg and of his life quality has dramatically improved. Patient #2, however, died of acute rejection with fatal sepsis at 5 months after transplantation. Patient #3 has survived for 3 years and 8 months enjoying a normal life. Postoperative recovery of all 3 donors was unremarkable. They were discharged 12 days after surgery without complications.

Conclusion: Outcomes of the implantation using the distal ileum as a graft in living-related small bowel transplantation have been satisfactory for both recipients and donors. It is feasible to anastomose the graft artery and vein to the recipient infrarenal aorta and vena cava. The intestinal continuity can be restored by a 1-stage strategy with minimal risk to the recipient. Appropriate application and adjustment of immune suppressors are crucial for the recipients to experience high-quality lives.