Gangemi Antonio, Tzvetanov Ivo G, Beatty Elizabeth, Oberholzer Jose, Testa Giuliano, Sankary Howard N, Kaplan Bruce, Benedetti Enrico
Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA.
Transplantation. 2009 Apr 15;87(7):1027-30. doi: 10.1097/TP.0b013e31819cc3bf.
Children are the primary candidates for intestinal transplant with more than 70% requiring a combined liver-bowel transplant. We report our single-center experience with living donor intestinal transplantation (LDITx) and combined living donor intestinal and liver transplant (CLDILTx) in pediatric patients.
Between October 2002 and June 2006, 13 living donor intestinal grafts were transplanted in 10 recipients. In five cases CLDILTx was performed. The intestinal grafts consisted of a 150-cm segment of ileum, whereas the liver transplant was completed using standard left lateral grafts.
No complications occurred in any donors. In CLDILTx recipients, the patient survival at 1 and 2 years was 100%, the liver graft survival 100%, and the bowel graft survival 80%; the patient who lost the initial intestinal graft was successfully retransplanted. In LDITx recipients, the patient and graft survival at 1 and 3 years were 60% and 50%, respectively. Two isolated LDITx recipients, both 6 months of age and low body weight (mean, 6 vs. 9 kg) died within 4 months posttransplant. One LDITx recipient developed chronic rejection 3.5 years after the original transplant and died after retransplant. All patients who are alive with functioning grafts are currently on full enteral feeding without need for any intravenous supplementation, except for a recipient of CLDILTx, currently on total parenteral nutrition for late fistula.
The early outcomes of intestinal transplantation from living donors are promising, particularly for candidates in need of CLDLITx. In this subgroup, the elimination of the high mortality on the cadaver waiting list (approximately 30%) represents a substantial advantage.
儿童是肠道移植的主要候选者，超过70%的患儿需要进行肝肠联合移植。我们报告了我们在儿科患者中进行活体供体肠道移植（LDITx）和活体供体肠道与肝脏联合移植（CLDILTx）的单中心经验。
2002年10月至2006年6月期间，10名受者接受了13例活体供体肠道移植。其中5例进行了CLDILTx。肠道移植物包括一段150厘米的回肠，而肝脏移植则采用标准的左外侧移植物完成。
所有供体均未出现并发症。在CLDILTx受者中，1年和2年的患者生存率为100%，肝脏移植物生存率为100%，肠道移植物生存率为80%；最初肠道移植物丢失的患者成功进行了再次移植。在LDITx受者中，1年和3年的患者及移植物生存率分别为60%和50%。两名孤立的LDITx受者，均为6个月大且体重低（平均分别为6千克和9千克），在移植后4个月内死亡。一名LDITx受者在原移植后3.5年发生慢性排斥反应，再次移植后死亡。所有存活且移植物功能良好的患者目前均完全通过肠内喂养，无需任何静脉补充，除了一名CLDILTx受者，目前因晚期瘘管正在接受全胃肠外营养。
活体供体肠道移植的早期结果很有前景，特别是对于需要CLDLITx的候选者。在这一亚组中，消除尸体等待名单上的高死亡率（约30%）具有显著优势。
