Advertisement

Intestinal/Multivisceral Transplantation: The Donor Procurement

  • Antonio D. Pinna
  • Chiara ZanfiEmail author

Abstract

Until the 1980s, a “cadaveric donor” was essentially synonymous of a kidney donor. When better immunosuppression brought transplantation of the liver, heart, and other extrarenal organs to a practical level, the ostensibly ethical concern of many kidney transplant surgeons was whether removal of multiple organs would result in damage to the renal allografts. Such anxieties were allayed by the development of procurement procedures that were flexible enough to allow the excision of all the organs above and below the diaphragm without jeopardizing any of the individual grafts. Techniques for multiple abdominal organ procurement were first described by Starzl and have been adopted throughout the world. However, it was initially thought that removal of the whole pancreas for transplantation would be incompatible with procurement of the liver, because both procedures originally called for retention of the celiac axis and portal vein with the respective allografts. It was subsequently demonstrated that the simultaneous retrieval of the intestine, pancreas, and liver from the same donor was shown to be routinely feasible, using modifications of the standard methods. To do this safely, it is necessary to have detailed knowledge of the vascular anatomy of all three organs.

Keywords

Small bowel Superior mesenteric artery Superior mesenteric vein Portal vein Vascular graft 

References

  1. 1.
    Abu-Elmagd K, Fung J, Bueno J, Martin D, Madariaga JR, Mazariegos G, Bond G, Molmenti E, Corry RJ, Starzl TE, Reyes J. Logistics and technique for procurement of intestinal, pancreatic and hepatic grafts from the same donor. Ann Surg. 2000;232(5):680–87.PubMedCentralCrossRefPubMedGoogle Scholar
  2. 2.
    Zanfi C, Cescon M, Lauro A, Dazzi A, Ercolani G, Grazi GL, Del Gaudio M, Ravaioli M, Cucchetti A, La Barba G, Zanello M, Cipriani R, Pinna AD. Incidence and management of abdominal closure-related complications in adult intestinal transplantation. Transplantation. 2008;85(11):1607–9.CrossRefPubMedGoogle Scholar
  3. 3.
    Fischer-Frohlich CL, Konigsrainer A, Shaffer R, Schaub F, Pratschke J, Pascher A, Steurer W, Nadaline S. Organ donation: when should we consider intestinal donation. Transpl Int. 2012;25(12):1229–40.CrossRefPubMedGoogle Scholar
  4. 4.
    Lauro A, Zanfi C, Ercolani G, Dazzi A, Golfieri L, Amaduzzi A, Grazi GL, Vivarelli M, Cescon M, Varotti G, Del Gaudio M, Ravaioli M, Pironi L, Pinna AD. Twenty-five consecutive isolated intestinal transplants in adult patients: a five-clinical experience. Clin Transplant. 2007;21(2):177–85.CrossRefPubMedGoogle Scholar
  5. 5.
    Greenstein SM, Sun SC, Senitzer D, Schechner RS, Tellis VA. Pretreatment with irradiation and donor-specific transfusion prolongs survival in small intestinal transplantation. Transplant Proc. 1993;25(1pt 1):490–1.PubMedGoogle Scholar
  6. 6.
    Starzl TE, Todo S, Tzakis A, et al. The many faces of multivisceral transplantation. Surg Gynecol Obstet. 1991;172(5):335–44.PubMedCentralPubMedGoogle Scholar
  7. 7.
    Nayyar N, Mazariegos G, Ranganathan S, Soltys K, Bond G, Jaffe R, Sun Q, Nucci A, Kosmach B, Squires R, Abu-Elmagd K, Sindhi R. Pediatric small bowel transplantation. Semin Pediatr Surg. 2010;19(1):68–77.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Division of General and Transplant Surgery Prof. A.D. PinnaUniversity of BolognaBolognaItaly

Personalised recommendations