Combined liver and intestinal transplantation: surgical procedures and treatment after operation (one case report)

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Author:
WEI Lai(Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China)
CHEN Xiao-ping(Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China)
CHEN Zhi-shui(Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China)
YANG Chuan-yong(Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China)
CAO Zhi-xin(Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China)
MING Chang-sheng(Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China)
DU Dun-feng(Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China)
CHEN Dong(Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China)
GUO Hui(Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China)
ZHOU Qi(Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China)
Journal Title:
Chinese Journal of Organ Transplantation
Issue:
Volume 33, Issue 09, 2012
DOI:
10.3760/cma.j.issn.0254-1785.2012.09.008
Key Word:
Liver transplantation;Small intestine transplantation;Combined transplantation

Abstract: Objective To discuss the surgical procedures and treatment after combined liver and intestinal transplantation with portal venous drainage and enterostomy of two ends in one case.Methods A male patient with liver dysfunction and short bowel syndrome underwent the combined liver and intestinal transplantation.With the techniques of "en bloc",the liver and intestinal grafts were harvested from cadaveric donor.The intestinal graft,200 cm long,was implanted with portal venous drainage and aortic inflow,and enterostomy of both ends was performed instead of intestinal anastomosis.The liver graft was placed in a piggyback fashion with end to end anastomosis of the bile ducts without T tube. Inmunosuppression protocol was administrated with campath-1H and tacrolimus.Endoscopic biopsy of intestinal graft was performed regularly,and clinical observation was done to monitor the acute rejection.Results In the first month after operation,abdominal infection was controlled by intraperitoneal drainage with open surgery.One suspect acute rejection was treated with methylprednisolone.Until sixth month,the functions of liver and intestine were progressively restored.However,the patient lost weight and could not be free from intravenous nutrition because of diarrhea.Conclusion Combined liver and intestinal transplantation with portal venous drainage and enterostomy of two ends is a simple surgical procedure with lower risk of surgical complications.This method is propitious to monitoring rejection and function improvement of the grafts.Diarrhea and loss of digestive juice are the main reasons of low body weight and malnutrition.

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