Intestinal twin-to-twin transplant for short gut: Review of the literature and discussion of a complex case
https://doi.org/10.4081/pmc.2022.287
Accepted: 19 September 2022
HTML: 10
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Paediatric Intestinal Transplantation (IT) presents the highest mortality on the waiting-list due to anatomical disproportion. Living-Donor IT (LDIT) offers the best advantages and when performed among identical monozygotic twins, it also benefits from unique immunology. According to MEDLINE/Pubmed, twin-to-twin LDIT has been performed in seven cases (6:7 males, median age of 32 years). None of the patients received immunosuppression postoperatively. Only one paediatric twinto- twin LDIT was carried out with a 160-cm mid-ileum tract: an interposed 4/5-cm arterial graft was required to ensure a tensionfree anastomosis to the anterior wall of the infra-renal abdominal aorta. In contrast, venous anastomosis was done directly to the inferior cava vein. We present a case for debate of a 13- month-old SBS patient where a twin-LDIT was discussed with parents, who decided to wait after careful analysis and ethical considerations.
Morabito A, Ugolini S, Cianci MC, Coletta R. Current surgical concepts and indications in the management of the short bowel state: A call for the use of multidisciplinary intestinal rehabilitation programs. Children 2021;8:654. DOI: https://doi.org/10.3390/children8080654
Goulet O, Ruemmele F. Causes and management of intestinal failure in children. Gastroenterology 2006;130:S16-28. DOI: https://doi.org/10.1053/j.gastro.2005.12.002
Bishay M, Pichler J, Horn V, et al. Intestinal failure-associated liver disease in surgical infants requiring long-term parenteral nutrition. J Pediatr Surg 2012;47:359-62. DOI: https://doi.org/10.1016/j.jpedsurg.2011.11.032
Yap JYK, Roberts AJ, Bines JE. Paediatric intestinal failure and transplantation. J Paediatr Child Health 2020;56:1747-53. DOI: https://doi.org/10.1111/jpc.15052
Tzvetanov IG, Tulla KA, D’Amico G, Benedetti E. Living donor intestinal transplantation. Gastroenterol Clin North Am 2018;47:369-80. DOI: https://doi.org/10.1016/j.gtc.2018.01.008
Gazit VA, Swietlicki EA, Liang MU, et al. Stem cell and niche regulation in human short bowel syndrome. JCI Insight 2020;5:e137905. DOI: https://doi.org/10.1172/jci.insight.137905
Lauro A, Panaro F, Iyer KR. Analyse de l’activité actuelle de transplantation intestinale en Europe et aux États-Unis. J Visceral Surg 2017;154:105-14. DOI: https://doi.org/10.1016/j.jchirv.2016.08.008
Celik N, Mazariegos G v., Soltys K, et al. Pediatric intestinal transplantation. Gastroenterol Clin North Am 2018;47:355-68. DOI: https://doi.org/10.1016/j.gtc.2018.01.007
Horslen SP, Smith JM, Weaver T, Cafarella M, Foutz J. OPTN/SRTR 2020 Annual Data Report: Intestine. Am J Transplant 2022;22:310-349. DOI: https://doi.org/10.1111/ajt.16992
Busch AM. Current status of small bowel transplantation a case study of transplant between identical twins. Gastroenterol Nurs 1999;22:170-4. DOI: https://doi.org/10.1097/00001610-199907000-00006
Berney T, Genton L, Buhler LH, et al. Five-year follow-up after pediatric living related small bowel transplantation between two monozygotic twins. Transplantation Proceedings 2004;36:316-8. DOI: https://doi.org/10.1016/j.transproceed.2004.01.103
Genton L, Raguso CA, Berney T, et al. Four year nutritional follow up after living-related small bowel transplantation between monozygotic twins. Gut 2003;52:659-62. DOI: https://doi.org/10.1136/gut.52.5.659
Morel P, Kadry Z, Charbonnet P, et al. Paediatric living related intestinal transplantation between two monozygotic twins: A 1-year follow-up. Lancet 2000;355:723-4. DOI: https://doi.org/10.1016/S0140-6736(99)05789-X
Wu G, Zhao Q, Wang M, et al. Identical twin small-bowel transplantation without maintenance immunosuppression: A 5-year follow-up and literature review. Transplant Direct 2018;4:e374. DOI: https://doi.org/10.1097/TXD.0000000000000807
Gheza F, di Bella C, Tulla K, et al. Small bowel transplantation in identical twins a video vignette. Colorectal Dis 2018;20:934. DOI: https://doi.org/10.1111/codi.14346
Schena S, Testa G, Setty S, et al. Successful identical-twin living donor small bowel transplant for necrotizing enterovasculitis secondary to Churg-Strauss syndrome. Transplant International 2006;19:594-7. DOI: https://doi.org/10.1111/j.1432-2277.2006.00316.x
Morris JA, Johnson DL, Rimmer JA, et al. Identical-twin small-bowel transplant for desmoid tumour. Lancet 1995;345:1577-8. DOI: https://doi.org/10.1016/S0140-6736(95)91130-8
Cicalese L, Sileri P, Rastellini C, et al. Living related small bowel transplantation. Graft 2008;4:526-34. DOI: https://doi.org/10.1177/152216280100400801
Calne RY, Friend PJ, Middleton S, et al. Intestinal transplant between two of identical triplets. Lancet 1997;350:1077-8. DOI: https://doi.org/10.1016/S0140-6736(05)70458-X
Copyright (c) 2022 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Downloads
Citations
