Open AccessIntestinal twin-to-twin transplant for short gut: Review of the literature and discussion of a complex case
Author(s) -
Sara Ugolini,
Riccardo Coletta,
Antonino Morabito
Publication year - 2022
Publication title -
pediatria medica e chirurgica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.336
H-Index - 16
eISSN - 2420-7748
pISSN - 0391-5387
DOI - 10.4081/pmc.2022.287
Subject(s) - medicine , anastomosis , surgery , immunosuppression , monozygotic twin , ileum , vein , transplantation , general surgery , genetics , biology
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.