REDUCED-SIZE ORTHOTOPIC COMPOSITE LIVER-INTESTINAL ALLOGRAFT

A composite graft consisting of a reduced left lateral hepatic segment in continuity with the small intestine was procured from an adult cad averic donor using a modified in situ split technique. The primary rec ipient was a 3-year-old boy with hepatointestinal failure. The right s ide of the liver was transplanted into a 63-year-old man with a centra l hepatoma and hepatitis C cirrhosis. This was accomplished with cente r-to-center sharing of the liver portion of the allograft. The in situ split technique was feasible, with good initial allograft function, H owever, both grafts failed subsequently because of peri-operative reci pient-related complications. The adult patient died of an infected pse udoaneurysm of the arterial graft, and the pediatric patient required repeat transplantation as a result of the late diagnosis of a native p ancreatic fistula with cholestatic damage to the reduced liver allogra ft. The child is currently alive 8 months after repeat transplantation .