Fujimoto Y, Uemoto S, Inomata Y, Egawa H, Fujita S, Kawanami T, Tsuruyama T, Hayashi M, Kiuchi T, Asonuma K, Tanaka K
Department of Transplantation and Immunology, Kyoto University Hospital, Japan.
Transpl Int. 2000;13 Suppl 1:S179-84. doi: 10.1007/s001470050321.
A living-related small bowel transplantation (SBT) was performed in two pediatric patients with short bowel syndrome. In both cases, the donor was the patient's mother. The distal ileum (100 cm, 120 cm) was harvested and the ileocolic vessels, ileocecal valve, and terminal ileum were left intact. The two donors were discharged from the hospital on postoperative days 15 and 6, respectively. Recipient 1 was a 2 year 6 month-old boy with short bowel syndrome who underwent SBT due to loss of venous access. The graft vein was anastomosed to the recipient's infrarenal inferior vena cava. Despite triple immunosuppression (tacrolimus, steroid, and azathioprine), there were four episodes of rejection. The patient had been on total parenteral nutrition for almost his entire posttransplant course. He died from Pneumocystis carinii pneumonia 16 months after the transplantation. Recipient 2 was a 4 year 5 month-old girl with short bowel syndrome who underwent an isolated small bowel transplantation because of recurrent line sepsis. Her pretransplant bilirubin was 8.0 mg/dl and a biopsy showed severe fibrosis. The graft vein was anastomosed to the recipient's inferior mesenteric vein. After transplantation, her bilirubin level became normal within 10 days. Triple immunosuppression (tacrolimus, steroid, and cyclophosphamide) together with a 3-day course of OKT-3 made her post-transplant course feasible. After overcoming a single episode of rejection she left the hospital 4 months after SBT. The patient is currently (10 months after transplantation) hospitalized due to rejection, which is being successfully controlled, and she is off total parenteral nutrition. From our experience, harvesting of the distal ileum for use as a bowel graft can be safely performed. The advantages of living-related grafts, optimal graft length, and choice of vascular reconstruction in SBT are yet to be explored.
对两名患有短肠综合征的儿科患者进行了亲属活体小肠移植（SBT）。在这两例手术中，供体均为患者的母亲。切取了远端回肠（分别为100厘米、120厘米），保留了回结肠血管、回盲瓣和末端回肠。两名供体分别在术后第15天和第6天出院。受体1是一名2岁6个月大的患有短肠综合征的男孩，因静脉通路丧失而接受SBT。移植的静脉与受体的肾下下腔静脉进行吻合。尽管采用了三联免疫抑制（他克莫司、类固醇和硫唑嘌呤），仍发生了4次排斥反应。该患者在移植后的几乎整个病程中一直接受全胃肠外营养。他在移植后16个月死于卡氏肺孢子虫肺炎。受体2是一名4岁5个月大的患有短肠综合征的女孩，因反复发生导管败血症而接受了单纯小肠移植。她移植前的胆红素水平为8.0毫克/分升，活检显示有严重纤维化。移植的静脉与受体的肠系膜下静脉进行吻合。移植后，她的胆红素水平在10天内恢复正常。三联免疫抑制（他克莫司、类固醇和环磷酰胺）联合3天的OKT-3疗程使她的移植后病程顺利。在克服了一次排斥反应后，她在小肠移植后4个月出院。该患者目前（移植后10个月）因排斥反应住院，排斥反应得到成功控制，并且已停止全胃肠外营养。根据我们的经验，可以安全地切取远端回肠用作肠移植。亲属活体移植物的优势、最佳移植物长度以及小肠移植中血管重建的选择尚有待探索。
