Small Bowel Transplantation in Identical Twins

Kiara A. Tulla, MD; Federico Gheza, MD; Caterina Di Bella, MD; Mario Spaggiari, MD; Ivo Tzvetanov, MD; Enrico Benedetti, MD, FACS

Product Details
Product ID: ACS-5509
Year Produced: 2018
Length: 7 min.


BACKGROUND: Living-related small bowel transplantation (LRSBTx) is a standardized procedure that represents a valid alternative to deceased donor bowel transplant in select cases with comparable outcomes. The availability of an identical twin as a donor allows avoidance of immunosuppressive therapy, a major indication for live donation. CASE REPORT: 32-year-old African American male who had ultra-short-bowel syndrome as a result of multiple gunshot wounds to the abdomen with subsequent mesenteric arterial and venous thrombosis requiring extensive bowel resection. He was treated with a duodeno-colostomy which was complicated by an anastomotic leak and fistula. The patient required total parenteral nutrition. The patient had a confirmed HLA-identical twin brother who became an immediate donor for LRSBTx. The donor underwent a successful ileal resection of 200 cm. A single arterial and venous conduit were used to extend the graft; end-to-side vascular anastomoses created with the right common iliac artery and the inferior vena cava, respectively. Intestinal continuity was restored. The donor's postoperative course included an ileus treated conservatively and was discharged on postoperative day (POD) 12. The recipient experienced an infected abdominal hematoma, which required reoperation on POD 8. He tolerated a regular diet within 7 days after reoperation. Nine months post-transplant, the donor has recovered well and the recipient enjoys a regular life without any evidence of rejection. CONCLUSIONS: Short-bowel syndrome can be successfully treated with LRSBTx. Availability of an identical twin-donor may represent an option that offers a perfect opportunity to avoid chronic immunosuppression post-transplant.