Living-related small bowel transplantation in adults: A report of two patients

Abstract

Virtually all of the small bowel transplants performed to date have utilized the whole intestine harvested from cadaveric donors. There may be distinct potential advantages to the transplantation of segments of small intestine. Experimentally, segments undergo adaptive hyperplasia, resulting in deeper crypts and taller villi. The increased mucosal surface area augments intestinal absorption and restores function in enterectomized animals. There is a direct relationship between the mass (length) of the graft and its immunogenicity in small animals, with longer segments rejecting more rapidly and mandating the use of higher doses of immunosuppression. Also, there is substantial immunologic advantage to the use of jejunum, rather than ileum in rats, although bowel from both sites otherwise function equally well. Finally, transplantation of segments would solve the problem of availability of intestine, and might overcome size restrictions, perhaps even permitting the use of adult donors for pediatric recipients. Based on these observations, and the potential advantage afforded by immediate revascularization, we initiated a program of living-related small intestinal transplantation in adults.