The survival rates after intestinal transplantation have cumulatively improved during the past decade. With the management strategies currently under evaluation, intestinal transplant procedures have the potential to become the standard of care for patients with end-stage intestinal failure.
ObjectiveTo assess a technique for simultaneous recovery of the intestine, pancreas, and liver from the same donor.
Summary Background OataWith the more frequent use of pancreatic and intestinal transplantation, a procurement procedure is needed that permits retrieval of both organs as well as the liver from the same cadaveric donor for transplantation to different recipients. It is believed by many procurement officers and surgeons, however, that this objective is not technically feasible.
MethodsA technique for simultaneous recovery of the intestine, pancreas, and liver was used in 13 multiorgan cadaver donors during a 26-month period, with transplantation of the organs to 33 recipients. The intestine was removed from 11 donors separately and in continuity with the pancreas in the other 2.With the improved results of both intestinal and pancreas transplantation with tacrolimus-based immunosuppression.I-1> there has been a commensurately increased demand for these procedures. However. it has been suggested that both organs cannot be obtained from the same cadaveric donor. particularly if the liver also is to be transplanted. The argument has been that because the three organs share an axial blood supply (Fig. I)
680Six additional pancreases were excised and transplanted separately. Thirteen livers were retrieved, one of which was discarded because of steahorrhea. Ten of the remaining 12 livers were transplanted intact; the other 2 were split in situ and used as reduced-size hepatic allografts in four recipients.
Our results confirm the claim that a new era has dawned for SBTx, such that, with continued progress, it can potentially become an alternative to HPN for the management of permanent intestinal failure, rather than a last-chance treatment for "TPN failure."
Improved long-term survival and outcome in pediatric Re-ITx may be attributed to improvements in initial immunosuppression protocols, technical modifications, proper timing, and improved infectious disease monitoring. Careful patient selection and posttransplant management are essential for successful long-term outcome.
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