Living related segmental bowel transplantation - From experimental to standardized procedure

被引:48
作者
Benedetti, Enrico
Holterman, Mark
Asolati, Massimo
Di Domenico, Stefano
Oberholzer, Jose
Sankary, Howard
Abcarian, Herand
Testa, Giuliano
机构
[1] Univ Illinois, Div Transplantat, Chicago, IL USA
[2] Univ Illinois, Div Pediat Surg, Chicago, IL USA
[3] Univ Illinois, Dept Surg, Chicago, IL 60680 USA
关键词
D O I
10.1097/01.sla.0000232555.02880.84
中图分类号
R61 [外科手术学];
学科分类号
摘要
Introduction: 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. Materials and 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.
引用
收藏
页码:694 / 699
页数:6
相关论文
共 16 条
[1]   Progressive functional adaptation of segmental, bowel graft from living related donor [J].
Benedetti, E ;
Baum, C ;
Cicalese, L ;
Brown, M ;
Raofi, V ;
Massad, MG ;
Abcarian, H .
TRANSPLANTATION, 2001, 71 (04) :569-571
[2]   Cost-effectiveness of early living related segmental bowel transplantation as therapy for trauma-induced irreversible intestinal failure [J].
Cicalese, L ;
Sileri, P ;
Gonzales, O ;
Asolati, M ;
Rastellini, C ;
Abcarian, H ;
Benedetti, E .
TRANSPLANTATION PROCEEDINGS, 2001, 33 (7-8) :3581-3582
[3]   Bacterial translocation in clinical intestinal transplantation [J].
Cicalese, L ;
Sileri, P ;
Green, M ;
Abu-Elmagd, K ;
Kocoshis, S ;
Reyes, J .
TRANSPLANTATION, 2001, 71 (10) :1414-1417
[4]   Low infectious complications in segmental living related small bowel transplantation in adults [J].
Cicalese, L ;
Sileri, P ;
Asolati, M ;
Rastellini, C ;
Abcarian, H ;
Benedetti, E .
CLINICAL TRANSPLANTATION, 2000, 14 (06) :567-571
[5]   The current state of intestinal transplantation [J].
Fishbein, TM .
TRANSPLANTATION, 2004, 78 (02) :175-178
[6]  
Fryer Jonathan, 2004, Prog Transplant, V14, P321
[7]  
GRUESSNER RW, 1997, TRANSPLANTATION, V11, P271
[8]   Indications for pediatric intestinal transplantation: A position paper of the American Society of Transplantation [J].
Kaufman, SS ;
Atkinson, JB ;
Bianchi, A ;
Goulet, OJ ;
Grant, D ;
Langnas, AN ;
McDiarmid, SV ;
Mittal, N ;
Reyes, J ;
Tzakis, AG .
PEDIATRIC TRANSPLANTATION, 2001, 5 (02) :80-87
[9]  
LENNARDJONES JE, 1990, TRANSPLANT P, V22, P2427
[10]   Long-term survival and parenteral nutrition dependence in adult patients with the short bowel syndrome [J].
Messing, B ;
Crenn, P ;
Beau, P ;
Boutron-Ruault, MC ;
Rambaud, JC ;
Matuchansky, C .
GASTROENTEROLOGY, 1999, 117 (05) :1043-1050