Department of Surgery, SUNY Downstate Health Sciences University, New York City, New York.
Transplant Proc. 2022 Sep;54(7):1944-1953. doi: 10.1016/j.transproceed.2022.05.022. Epub 2022 Aug 4.
A safe, reproducible and standardized surgical technique for intestinal procurement and transplantation from a living donor (LD) was introduced in 1997 and has been used in the majority of cases since. The key principles are: 1. procurement of 180-200 cm of distal ileum in adults (about 60-150 cm in pediatric recipients depending on age and weight) on a vascular pedicle comprising the LD ileocolic vessels or terminal branches of the superior mesenteric vessels, 2. the terminal ileum (30-40 cm of the most distal ileum), the ileocecal valve and the cecum remain with the donor to not interfere with B12-absorption and bowel transit time, 3. systemic venous drainage with anastomoses between the LD ileocolic vessels and the recipient's infrarenal aorta and vena cava, and 4. restoration of recipient bowel continuity through proximal anastomosis and distal graft ileostomy for biopsy access and graft monitoring. Recipients of a successful LD intestinal transplant become total parenteral nutrition (TPN)-independent within a few weeks posttransplant. LD vs deceased donor (DD) intestinal transplants can be performed in a more timely fashion. Hence, LD (in contrast to DD) intestinal transplants are also pre-emptive procedures in patients with advanced, but still reversible, TPN-induced liver disease and help reduce the wait-list mortality for combined DD intestinal and liver transplants. Life-saving combined LD intestinal and liver transplants, albeit rare, have also been successfully performed either simultaneously or subsequently. There have been no reported deaths or major complications of living intestinal donors. A better metabolic profile has been reported in some donors post-donation. In total, 85 documented LD intestinal transplants have been performed worldwide at over 20 different transplant centers in 12 different countries. In about 70 transplants, the standardized technique was used. There has been no difference in outcome between LD vs DD intestinal transplants. Long-term studies have shown that > 10 year of graft function is not uncommon. Since the introduction of the standardized surgical technique, LD intestinal transplantation has evolved from an experimental to an established and standardized procedure.
1997 年引入了一种安全、可重复且标准化的手术技术，用于从活体供体（LD）获取和移植肠道，并自那时起已在大多数情况下使用。关键原则如下：1. 在 LD 回结肠血管或肠系膜上血管的终末分支的血管蒂上获取成人 180-200cm 的远端回肠（儿科受者的长度约为 60-150cm，取决于年龄和体重），2. 保留末端回肠（最远端回肠的 30-40cm）、回盲瓣和盲肠，以不干扰 B12 吸收和肠转运时间，3. 采用 LD 回结肠血管与受者肾下主动脉和腔静脉之间的吻合进行全身静脉引流，4. 通过近端吻合和远端移植物回肠造口术恢复受者肠连续性，以便进行移植物活检和监测。成功进行 LD 肠移植的受者在移植后数周内即可无需全胃肠外营养（TPN）。LD 与已故供体（DD）肠移植可以更及时地进行。因此，LD（与 DD 相反）肠移植也是 TPN 诱导的肝疾病进展但仍可逆转的患者的抢先移植程序，有助于降低 DD 肠和肝联合移植的等待名单死亡率。尽管罕见，但已成功实施了挽救生命的 LD 肠和肝联合移植，既可以同时进行，也可以随后进行。尚无报道称 LD 肠供体出现死亡或重大并发症。一些供体在捐赠后报告代谢情况得到改善。全世界共有 20 多个不同的移植中心在 12 个不同的国家共进行了 85 例有记录的 LD 肠移植。约 70 例移植采用了标准化技术。LD 与 DD 肠移植的结果无差异。长期研究表明，超过 10 年的移植物功能并不罕见。自标准化手术技术引入以来，LD 肠移植已从实验性转变为成熟且标准化的程序。
