Size reduction of small bowels from adult cadaveric donors to alleviate the scarcity of pediatric size-matched organs - An anatomical and feasibilitystudy

Background. Small bowel transplantation in children weighing less than 10 k g is hindered by the lack of size-matched donors. The ability to create red uced size small bowel grafts from adult cadaveric donors suitable for use i n young children has been studied. Methods. Volumetric assessment of computed tomography scans were used to ev aluate abdominal cavity and small bowel volumes in children. Small bowels w ere retrieved from adult cadaveric donors and reduced in size. Results. Computed tomography studies of the abdominal cavity showed that th e mean volume available for a small bowel graft was 260 ml in children less than 5 kg (n=5) and 460 ml in children weighing 5-10 Bg (n=5). Fifteen sma ll bowels were successfully reduced to provide an ileal graft of one meter while Beeping the whole length of the superior mesenteric artery and vein a fter their dissection in the proximal part of the mesentery. The mean volum e of the grafts created was 270 ml in seven thin patients (body mass index [BMI] <25), 390 ml in five preobese patients (25 < BMI<30), and 490 ml in t hree obese patients (BMI>30). Mesenteric transillumination in thin donors a llowed safe dissection and complete hemostasis. No diameter reduction was r equired. Technical modifications permitted the creation of two grafts, one ileal and the other jejunal from a single donor. Volumetric and surgical da ta show that implantation of up to two meters of ileum from a thin adult we ighing up to 80 kg is feasible in children weighing less than 10 kg. Conclusion. Size reduction of adult cadaveric small bowels can provide suit able grafts for children of less than 10 Bg and could expand the potential pool of donors for these patients.