Gruessner R W, Sharp H L
Department of Surgery, University of Minnesota, Minneapolis 55455, USA.
Transplantation. 1997 Dec 15;64(11):1605-7. doi: 10.1097/00007890-199712150-00019.
Intestinal transplants using cadaver donors have become an alternative to total parenteral nutrition (TPN) for the treatment of irreversible intestinal failure. Intestinal transplants using living-related donors have rarely been attempted, and the surgical technique has not been standardized.
We performed a living-related intestinal transplant for a paraplegic, 16-year-old boy with life-threatening TPN complications, including lack of vascular access, recurrent line infections, and intermittent liver dysfunction.
A four antigen-matched donor (father) underwent resection of 200 cm of the ileum on a vascular pedicle comprising the ileocolic artery and vein. This resection left the donor with 300 cm of proximal small bowel, 20 cm of the most distal terminal ileum, the ileocecal valve, and all of the large intestine. The donor's ileocolic artery and vein were anastomosed to the recipient's infrarenal aorta and cava; bowel continuity was restored with an end-to-end anastomosis between the recipient's jejunum and the donor's ileum. Both donor and recipient had uneventful postoperative courses. Recipient maintenance immunosuppression has been with tacrolimus, mycophenolate mofetil, and prednisone. One year after transplant, urine methylmalonic acid indicates good vitamin B12 absorption in both the donor and recipient. The recipient has been completely off TPN since discharge (posttransplant day 21), has gained 20 kg, and has had no evidence of rejection, infection, or graft-versus-host disease.
Intestinal transplants from living-related donors can be lifesaving for selected patients with chronic intestinal failure and can be done with minimal risk to the donor.
使用尸体供体的肠道移植已成为治疗不可逆性肠衰竭的全胃肠外营养（TPN）替代方案。使用亲属活体供体的肠道移植很少尝试，且手术技术尚未标准化。
我们为一名患有威胁生命的TPN并发症（包括血管通路缺乏、反复的导管感染和间歇性肝功能障碍）的16岁截瘫男孩进行了亲属活体肠道移植。
一位四抗原匹配的供体（父亲）在包含回结肠动脉和静脉的血管蒂上切除了200 cm的回肠。此次切除使供体保留了300 cm的近端小肠、最远端20 cm的回肠末端、回盲瓣以及所有大肠。供体的回结肠动脉和静脉与受体的肾下主动脉和下腔静脉进行吻合；通过受体空肠与供体回肠的端端吻合恢复肠道连续性。供体和受体术后过程均顺利。受体维持免疫抑制采用他克莫司、霉酚酸酯和泼尼松。移植后一年，尿甲基丙二酸表明供体和受体的维生素B12吸收良好。受体自出院（移植后第21天）起已完全停用TPN，体重增加了20 kg，且无排斥、感染或移植物抗宿主病的迹象。
亲属活体供体的肠道移植对某些慢性肠衰竭患者可挽救生命，且对供体的风险极小。
