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[活体供体小肠移植。拉丁美洲首例报告]

[Living-donor intestinal transplantation. First report in Latin-American].

作者信息

Mendoza-Sánchez Federico, Sereno-Trabaldo Stefano, Montemayor-Cantú Gilberto, Benítez-Sánchez Carlos, Montes-López Adolfo, Manfredi-Sagnelli Francisco, Ortega-Godínez Fernando, Pelayo-Orozco Luis Angel, Gómez-Navarro Benjamin, Castillejos-Molina Luis Fernando

机构信息

Trasplantes, Hospital Centro Médico Puerta de Hierro, Zapopan, Jalisco, México.

出版信息

Rev Invest Clin. 2011 Sep;63 Suppl 1:96-100.

Abstract

INTRODUCTION

Intestinal transplants as opposed to total parenteral nutrition is more physiological alternative to long term in patients with irreversible intestinal failure. According to the Intestinal Transplant Registry and the Organ Transplant Network there are 32 living-donor and 957 cadaveric-donor intestinal transplants worldwide. In Latin America there are no reports on this subject. We present the first successful case of intestinal transplantation from living donor in Latin America.

CASE REPORT

Male patient, 20 years old, with short bowel, secondary to fire gun injuries that irreversibly affected mesenteric circulation so it was necessary to completely remove the small intestine, right and transverse colon. The patient needed ambulatory total parenteral nutrition and had hepatic failure related to it. The 44-year-old father of the patient was the intestinal living donor. Cold ischemia time was 16 min and warm ischemia time of 47 min. Immunosuppression was based on thymoglobulin, methylprednisolone, tacrolimus and mycophenolic acid. One month after the transplantation, the patient is well and the intestinal graft has adequate and functioning state, without evidence of rejection.

CONCLUSION

Intestinal transplantation in our country is a procedure that can be performed with good outcome and offers a unique therapeutic alternative for a patient with irreversible intestinal failure.

摘要

引言

与全胃肠外营养相比,肠道移植对于不可逆性肠衰竭患者而言是一种更符合生理的长期替代方案。根据肠道移植登记处和器官移植网络的数据,全球有32例活体供体肠道移植和957例尸体供体肠道移植。在拉丁美洲,尚无关于此主题的报道。我们报告拉丁美洲首例活体供体肠道移植成功病例。

病例报告

一名20岁男性患者,因火枪伤导致短肠,肠系膜循环受到不可逆影响,因此必须完全切除小肠、右半结肠和横结肠。患者需要非卧床全胃肠外营养,并因此出现肝功能衰竭。患者44岁的父亲为活体供体。冷缺血时间为16分钟,热缺血时间为47分钟。免疫抑制方案基于抗胸腺细胞球蛋白、甲泼尼龙、他克莫司和霉酚酸。移植术后一个月,患者情况良好,肠道移植物状态良好且功能正常,无排斥反应迹象。

结论

在我国,肠道移植是一种可以取得良好效果的手术,为不可逆性肠衰竭患者提供了独特的治疗选择。

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