Multivisceral and isolated intestinal procurement techniques

Abstract

Improved outcomes in multivisceral and isolated intestinal transplantation have generated increased demand for these procedures. Enhanced recognition of potential multivisceral/intestinal donors and widespread application of advanced organ procurement techniques is necessary in the current climate of organ scarcity. This manuscript details the multivisceral and isolated intestinal procurement techniques currently performed at the University of California Los Angeles. (Liver Transpl 2003;9:881-886.)I mproved outcomes after multivisceral and isolated intestinal transplantation [1][2][3][4][5][6] have renewed interest in these techniques as evidenced by United Network for Organ Sharing (UNOS) data showing annual increases in isolated intestinal and multivisceral transplantation since 1998. 7 In an era of limited cadaver-donor supply, enhanced recognition of potential multivisceral/intestinal cadaver-donors is necessary. This article details the techniques applied by our donor recovery team in performing multivisceral and isolated intestinal procurements.The procurement techniques herein are a modification of the original descriptions of Starzl et al, [8][9][10] Bueno et al, 11 and Abu-Elmagd et al 12 of the University of Pittsburgh. Our technique has been routinely used at donor medical facilities without specialized equipment and has not precluded additional abdominal and thoracic organ retrieval.Multivisceral organ procurement requires tailoring the donor procedure for the individual needs of a recipient. Donor selection is restricted to optimal candidates according to widely recognized criteria 6,13 including ABO compatibility, appropriate size-match, minimal vasopressor requirements, absent/scant arrest period, serum sodium Ͻ 160 mEq/dL. Preparation of the donor before procurement includes selective intestinal decontamination using neomycin, erythromycin, and amphotericin B, in addition to intravenous antibiotic prophylaxis with a third-generation cephalosporin at the time of surgery. 12 Procurement of Multivisceral and Liver/Intestine AllograftsAll procedures begin with the standard techniques of abdominal organ procurement. 14 A thorough celiotomy is performed with particular attention to evidence of traumatic injury, the presence of mesenteric or retroperitoneal hematoma, and assessment of organ perfusion. The round ligament is divided, and the falciform is dissected to the hepatic vein/inferior vena cava confluence. Medially, the left coronary and triangular ligaments are released and the gastrohepatic ligament is assessed for aberrant hepatic arterial anatomy. The supraceliac dissection proceeds with division of the gastrohepatic ligament as well as the right diaphragmatic crus to expose the supraceliac aorta. 14 Infrarenal aortic dissection is initiated with medial rotation of the colon and duodenum en bloc as described by Cattel-Braash et al. 15 The inferior mesenteric vein is isolated and cannulated to begin a pre-cool perfusion with isotonic (donor serum sodium Ͻ 150 mEq/dL) or hypotonic (donor serum s...

Organ donation: when should we consider intestinal donation

“…The literature suggests that ideal intestinal donor should be younger than 50 years [5,6,8–13,27,34]. Although donors older than 50 years have been used successfully [9,34], our results were similar to those reported in the literature with most donors being younger than 18 years and only one over 50 years of age.…”

“…The median ICU stay in our series was 2 days [1–10]. This was similar to the reported data in the literature [8–13,22,27]. There is consensus that intensive donor therapy improves the quality of organs [28].…”

Futility Versus Acceptability of the Use of Grafts Taken From End of Line in the National Organ-Sharing Network

“…Thus, cadaveric organ donors with high serum sodium levels can be safely transplanted. However, we often perfuse sodium-free hypotonic fluid through the inferior mesenteric vein during harvesting [24].…”

Twenty‐five consecutive isolated intestinal transplants in adult patients: a five‐yr clinical experience

“…Organ procurement was performed using an in vivo technique (4–9). Small bowel was evaluated for ischaemia, oedema, pulsatility, peristalsis and the mesentery was inspected for haematomas or injuries.…”