Intestinal and Multivisceral Transplantation
Intestinal transplantation has evolved from an experimental procedure with limited success to standard of care for patients with intestinal and parenteral nutrition failure, achieving outcomes commensurate with other solid-organ transplants (Grant et al. 2005; Fishbein 2009). Paramount to achieving the success of intestinal and multivisceral organ transplant procedures has been the refinement of donor organ procurement and transplantation techniques (Fishbein et al. 2003a). Early graft failures and deaths due to technical and donor-related complications have been minimized using the techniques described here, leaving the current challenge largely of optimizing immunologic and infection management strategies (Fishbein 2004; Fishbein and Matsumoto 2005). The techniques depicted here are those of choice in our experience, though mention is made of alternative techniques that others may prefer (Abu-Elmagd et al. 2000; Fishbein et al. 2003b; Reyes et al. 1998; Tzakis et al. 1993). Because patients requiring intestinal transplantation often present with multiple organ failure and require multiorgan transplantation, modification of these techniques may be required to meet the needs of an individual patient. Some of the modifications that we have encountered include the addition of renal allotransplantation, inclusion of the colon in a small-bowel or multivisceral graft, and modified multivisceral transplantation with preservation of the native liver. Intimate description of all possible technical variations that might be required is beyond the scope of this chapter, and intestinal transplant surgeons should be prepared to draw from their experience in gastrointestinal and transplant surgery and employ generally accepted tenets as necessary.
KeywordsIntestine transplantation Surgical techniques Donor procedure Back-table procedure Recipient procedure Vascular reconstruction Liver-intestine-pancreas transplantation Multivisceral transplantation Living-donor intestinal transplantation
Living donor intestinal transplant (Humar) (WMV 87560 kb)
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