En bloc combined reduced-liver and small bowel transplants

From large donors to small children

Jean De Ville De Goyet, Andrew Mitchell, A. David Mayer, Sue V. Beath, Patrick J. Mckiernan, Deirdre A. Kelly, Darius Mirza, John A C Buckles

Research output: Contribution to journalArticle

80 Citations (Scopus)

Abstract

Background. The critical shortage of size-matched donor organs for infants and small children in need of combined liver and intestinal transplantation has lead to long waiting times and a high risk of dying before transplantation. Utilizing grafts from larger donors could alleviate this problem, but using larger composite grafts in small children has been challenging and unsuccessful in the past. Methods. We conducted a pilot study for evaluating the results of transplanting into small recipients a composite graft (reduced-size liver and whole small bowel, including duodenum and pancreas head) procured from large donors. Liver size reduction was performed ex situ using the extrahilar approach, which leaves the liver hilum untouched. Straightforward implantation of the graft was performed by simple, two-step vascular anastomoses. The preservation of the donor duodenum in continuity with the combined graft avoided the need for biliary reconstruction, thus preserving maximal bowel length for gut continuity restoration in the recipient. Results. Two children, weighing 7.6 and 9.8 kg, respectively, underwent transplantation of a composite graft procured from donors weighing 35 kg. Their waiting time (68 and 97 days, respectively) was shorter compared with our previous experience with conventional techniques. Both are currently alive and well, at home and on full enteral feeds, 15 and 11 months after transplantation, respectively. Conclusion. This new technique has extended the range of possible donors for small candidates waiting for combined grafts and was successful in two patients. It should be considered for small recipients in the future.

Original languageEnglish
Pages (from-to)555-559
Number of pages5
JournalTransplantation
Volume69
Issue number4
Publication statusPublished - Feb 27 2000

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Tissue Donors
Transplants
Liver
Transplantation
Duodenum
Liver Transplantation
Small Intestine
Blood Vessels
Pancreas

ASJC Scopus subject areas

  • Immunology
  • Transplantation

Cite this

De Ville De Goyet, J., Mitchell, A., Mayer, A. D., Beath, S. V., Mckiernan, P. J., Kelly, D. A., ... Buckles, J. A. C. (2000). En bloc combined reduced-liver and small bowel transplants: From large donors to small children. Transplantation, 69(4), 555-559.

En bloc combined reduced-liver and small bowel transplants : From large donors to small children. / De Ville De Goyet, Jean; Mitchell, Andrew; Mayer, A. David; Beath, Sue V.; Mckiernan, Patrick J.; Kelly, Deirdre A.; Mirza, Darius; Buckles, John A C.

In: Transplantation, Vol. 69, No. 4, 27.02.2000, p. 555-559.

Research output: Contribution to journalArticle

De Ville De Goyet, J, Mitchell, A, Mayer, AD, Beath, SV, Mckiernan, PJ, Kelly, DA, Mirza, D & Buckles, JAC 2000, 'En bloc combined reduced-liver and small bowel transplants: From large donors to small children', Transplantation, vol. 69, no. 4, pp. 555-559.
De Ville De Goyet J, Mitchell A, Mayer AD, Beath SV, Mckiernan PJ, Kelly DA et al. En bloc combined reduced-liver and small bowel transplants: From large donors to small children. Transplantation. 2000 Feb 27;69(4):555-559.
De Ville De Goyet, Jean ; Mitchell, Andrew ; Mayer, A. David ; Beath, Sue V. ; Mckiernan, Patrick J. ; Kelly, Deirdre A. ; Mirza, Darius ; Buckles, John A C. / En bloc combined reduced-liver and small bowel transplants : From large donors to small children. In: Transplantation. 2000 ; Vol. 69, No. 4. pp. 555-559.
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