Kumaran Vinay, Mehta Naimish N, Varma Vibha, Pandey Shashank, Rao Prashantha S, Nath Barun, Mallya Ashwin, Bansal Naresh, Ghuman Samarjit, Bhalla Sunita, Nundy Samiran
Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi 110 060, India.
Indian J Gastroenterol. 2012 Jul;31(4):179-85. doi: 10.1007/s12664-012-0242-9. Epub 2012 Sep 5.
We describe the first living donor intestinal transplant (LDIT) in India and discuss the indications and problems of this complex procedure.
A 43-year-old male patient required massive bowel resection for gangrene due to thrombosis of the superior mesenteric artery. He was maintained on parenteral nutrition but developed cholestasis and well as repeated catheter related infections with progressive loss of venous access due to thrombosis of central veins. A LDIT was performed using 200 cm of small intestine from the patient's son. The graft was based on the continuation of the superior mesenteric vessels beyond the ileocolic branch. The artery was anastomosed directly to the aorta and the vein to the venacava.
The graft functioned well and he was weaned off parenteral nutrition. However, he later developed complications (wound dehiscence and enterocutaneous fistula) and developed sepsis. He succumbed to sepsis with a functioning graft 6 weeks after the transplant. The donor recovered uneventfully and was discharged on the 4th postoperative day.
LDIT can be life saving in patients with intestinal failure and failure of parenteral nutrition. There is a need to introduce this modality in India. In a setting of scarcity of deceased donor organs the living donor option has advantages.
我们描述了印度首例活体供体小肠移植（LDIT），并讨论了这一复杂手术的适应症和问题。
一名43岁男性患者因肠系膜上动脉血栓形成导致坏疽，需要进行大范围肠切除。他依靠肠外营养维持，但出现了胆汁淤积，以及反复发生的导管相关感染，由于中心静脉血栓形成，静脉通路逐渐丧失。使用患者儿子提供的200厘米小肠进行了LDIT。移植物基于肠系膜上血管在回结肠分支以外的延续。动脉直接与主动脉吻合，静脉与腔静脉吻合。
移植物功能良好，他逐渐停用了肠外营养。然而，他后来出现了并发症（伤口裂开和肠皮肤瘘）并发生了败血症。移植后6周，他因败血症死亡，移植物功能良好。供体恢复顺利，术后第4天出院。
LDIT对肠衰竭和肠外营养失败的患者可能挽救生命。有必要在印度引入这种治疗方式。在已故供体器官稀缺的情况下，活体供体选择具有优势。
