Uemoto S, Fujimoto Y, Inomata Y, Egawa H, Asonuma K, Pollard S, Tanaka K
Department of Transplantation and Immunology, Kyoto University School of Medicine, Japan.
Pediatr Transplant. 1998 Feb;2(1):40-4.
Intestinal failure has been managed with total parenteral nutrition (TPN), but occasionally complications such as obliteration of venous access or liver dysfunction occur. To overcome such complications, small bowel transplantation (SBT) was introduced. Since the introduction of tacrolimus in 1990, successful SBT cases have been reported. We performed SBT by using a living donor for a child with short bowel syndrome. The recipient (2.5 years old, male) was born with intestinal necrosis secondary to midgut volvulus. The length of the remaining small bowel was 30 cm. While being managed with TPN, his venous access gradually obliterated. Long-term survival could not be expected because of the difficulty in securing TPN access. The donor was his mother, whose distal ileum (100 cm) was used as a graft. The immunosuppression regimen consisted of tacrolimus, steroids and azathioprine. Three episodes of severe rejection and subsequent episodes of viral (EBV, CMV) infection were managed with steroid pulse therapy and antiviral drugs, respectively. The recipient suffered from anastomotic stenosis, and an operation was performed 13 months after transplantation to resect the stenotic segment. However, the patient died of Pneumocystis carinii pneumonia 16 months after transplantation. We conclude that organ retrieval from a living donor can be performed safely for SBT, but further study of the management of rejection as well as of viral infection is necessary, as it is for non-living-related SBT.
肠衰竭一直通过全胃肠外营养（TPN）进行治疗，但偶尔会出现诸如静脉通路闭塞或肝功能障碍等并发症。为克服这些并发症，引入了小肠移植（SBT）。自1990年引入他克莫司以来，已有成功的SBT病例报道。我们为一名患有短肠综合征的儿童使用活体供体进行了SBT。受者（2.5岁，男性）出生时因中肠扭转继发肠坏死。剩余小肠长度为30厘米。在接受TPN治疗期间，他的静脉通路逐渐闭塞。由于难以确保TPN通路，无法预期长期存活。供体是他的母亲，其远端回肠（100厘米）被用作移植物。免疫抑制方案包括他克莫司、类固醇和硫唑嘌呤。分别通过类固醇冲击疗法和抗病毒药物处理了三次严重排斥反应以及随后的病毒（EBV、CMV）感染发作。受者出现吻合口狭窄，并在移植后13个月进行手术切除狭窄段。然而，患者在移植后16个月死于卡氏肺孢子虫肺炎。我们得出结论，对于SBT，从活体供体获取器官可以安全进行，但与非亲属活体SBT一样，有必要进一步研究排斥反应以及病毒感染的处理。
