Cadaveric small bowel split liver transplantation in a child

Scarcity of size-matched grafts continues to be a major limiting factor for liver and combined liver/intestinal transplants in the pediatric populatio n. It is reported that 29 % of pediatric patients listed for hepatic transp lantation die while waiting for a donor. The reported mortality of pediatri c patients awaiting intestinal transplantation is about 40 %. We report on a technique of segmental liver and intestinal transplantation in a child. T o our knowledge, this is the first report of a combined split liver-intesti nal transplantation. We used a cadaveric donor, but the technique can also be performed with a live donor. The adult recipient of one segment of the l iver was discharged home without complications. The child who received the combined liver intestinal graft developed intestinal perforation and severe rejection and died. If this technique is applied successfully, the adverse effects and mortality of a long pretransplant waiting period in pediatric patients may be avoided.