P3.55: Allointestine colon conduit urinary diversion in combined intestine and kidney transplant: A case report

Abstract

Introduction: In intestinal transplant candidates, the incidence of renal failure is high and is associated with increased mortality. Additionally previous surgeries and loss of abdominal domain may make standard kidney transplant with ureterocystostomy impossible. . Methods: We present an extreme case of combined small intestine, colon, and kidney transplant in a patient with short gut syndrome due to radiation enteritis, severe loss of abdominal domain, failed previous kidney transplant, and absence of native urinary system. Results: Our patient is a forty years old female with a past history of bladder Rabdomyosarcoma as an infant, who underwent bladder resection and post resection radiation. She developed radiation enteritis, renal failure, and eventually received a living related kidney transplant. Her renal allograft subsequently failed due to multiple urinary obstructions despite multiple revision surgeries, as well as chronic immunosuppression toxicity. As a result, she had short gut syndrome and renal failure with no feasible route of urinary drainage. In addition, she had severe loss of abdominal domain due to abnormal abdominal development from the radiation she received as an infant. She had multiple complications of her short gut syndrome and she underwent a simultaneous small intestine, colon, and kidney transplant. Donor was an eight years old female (132 cm, 23.4 kg), who became brain dead after severe exacerbation of asthma attack. Since there were no viable routes for urinary drainage, as there were no viable native intestines, and native and previous transplanted kidney ureter had been obstructed, a 10 cm allograft colon segment was used as a urinary conduit. The patient also underwent a complex abdominal closure with pedicled left anterior lateral thigh perforator flap by the plastic surgery team. One hundred days post transplant the patient is parenteral nutritional independent with normal renal function and her transplant colon conduit is healthy and functional. Conclusion: In extreme cases of kidney transplant in intestinal transplant recipient patients with no feasible urinary drainage path, transplant intestine can successfully be used as a conduit. In review of literature, and to the best of our knowledge, this is the first description of utilization of allograft intestine as a urinary conduit.