Transplantation en bloc du foie, de l'estomac, du pancréas et de l'intestin grêle chez un tout-petit. A propos d'un cas [En bloc transplantation of liver, stomach, pancreas and small intestine in an infant. Apropos of a case].

Details

Serval ID
serval:BIB_86EBF72F89A5
Type
Article: article from journal or magazin.
Publication sub-type
Case report (case report): feedback on an observation with a short commentary.
Collection
Publications
Title
Transplantation en bloc du foie, de l'estomac, du pancréas et de l'intestin grêle chez un tout-petit. A propos d'un cas [En bloc transplantation of liver, stomach, pancreas and small intestine in an infant. Apropos of a case].
Journal
Chirurgie; Mémoires de l'académie de Chirurgie
Author(s)
Boudjema K., Cinqualbre J., Simeoni U., Jaeck D., Geiss S., Bientz J., Odeh M., Chenard-Neu M.P., Wolf P., Geisert J.
ISSN
0001-4001 (Print)
ISSN-L
0001-4001
Publication state
Published
Issued date
1991
Peer-reviewed
Oui
Volume
117
Number
10
Pages
860-6; discussion 867
Language
french
Notes
Publication types: Case Reports ; English Abstract ; Journal Article Publication Status: ppublish
Abstract
The now common practice of joint kidney and pancreas or heart or lung transplantation is being completed by other combinations. This is shown by our case of en bloc liver-pancreas-stomach-duodenum-small bowel transplantation in an 18-month-old infant with small bowen atresia complicated by biliary cirrhosis secondary to total parenteral feeding, after the failure of an intraperitoneal visceral transplant at 1 year of age. The graft was taken from an 8-year-old donor and was not pretreated. Being made of the whole intraperitoneal visceral mass, it had to be adapted to the recipient's size by ex vivo exeresis of the right liver, of the spleen, of the terminal ileon and of the colon. Following intraperitoneal visceral exenteration in the recipient, the graft was inserted in an orthoptic position with a digestive reconstruction by esogastric anastomosis and terminal ileostomy. Immunosuppression combined steroids, azathioprine, ciclosporine, and the biological and immunological follow-up regarded the hepatic and pancreatic functions. The intestinal graft was controlled by repeated biopsies through the stomy. Rectal biopsies and lymphocyte typing in the peripheral blood allowed watching for the occurrence of a possible graft-versus-host disease. The outcome was marked by the persistence of massive lymphorrhea during three months and severe central neurological disorders caused by the difficulties to adapt the level of ciclosporine. The hepatic and pancreatic functions became normal within a few days, and the intestinal function allowed progressively suppressing parenteral feeding.(ABSTRACT TRUNCATED AT 250 WORDS)
Keywords
Humans, Immune Tolerance, Infant, Intestine, Small/transplantation, Liver Transplantation, Male, Pancreas Transplantation, Short Bowel Syndrome/surgery, Stomach/transplantation, Suture Techniques
Pubmed
Create date
22/02/2015 8:58
Last modification date
20/08/2019 14:46
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