Intestinal Transplant Techniques: From Isolated Intestine to Intestine in Continuity with Other Organs
Intestine transplantation has revolutionized the management of the pediatric patient with intestine failure and total parenteral nutrition-related complications. Pediatric intestinal transplantation is a technically demanding procedure, requiring intimate knowledge of advanced techniques in both pediatric liver transplantation and gastrointestinal surgery. Individualization of the procedure is required based on recipient gastrointestinal anatomy, function, and vascular complications of parenteral nutrition in the child. The term “intestinal transplant” comprises not only isolated intestinal transplant but also combined liver–intestinal and multivisceral transplants. When only the jejunum and ileum are transplanted, this is conventionally known as an isolated intestinal transplant. In the setting of advanced liver disease, combined liver and intestine are generally transplanted en bloc with the pancreas. The native foregut is preserved in children whenever possible, and venous drainage with a portacaval shunt is required. This variation is referred to as a liver–intestine transplant. Multivisceral transplantation incorporates the stomach and entire duodenum with the liver and intestine graft. The modified multivisceral variant excludes the liver and is rarely employed in children. Paramount to the success of intestine transplantation has been the refinement of recipient transplantation techniques. Appropriate technical and logistical planning will minimize technical failures, which have long-term implications in the pediatric recipient.
KeywordsAbdominal closure Acute rejection Enterectomy Gastrectomy Intestine failure Intestine transplant Multiorgan transplant Multivisceral transplant Parenteral nutrition Portacaval shunt Sensitization Short gut syndrome Vascular conduit
We kindly thank David Klemm for his artistic expertise in creating figures 1, 4, 7, 10.
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