Subject(s)
Gastrectomy/methods , Kidney Transplantation , Laparoscopy/methods , Obesity/surgery , Weight Loss , Female , Humans , MaleABSTRACT
Very small pediatric donors are underutilized for pancreas and kidney transplantation for the fear of inadequate islet mass and higher incidence of technical complications, and the lower age limit for such donors is not well defined. We present here two cases of combined pancreas and en bloc kidney transplantation from very small pediatric donors (14 and 18 months old) to adult type 1 diabetic and uremic patients. The conventional surgical procedure for simultaneous pancreas and kidney transplantation with systemic venous and bladder exocrine drainage was successfully applied to very small organs. For both, we utilized the recently described bladder patch technique for ureteral reconstruction. One patient developed venous thrombosis (partial thrombosis of the splenic and mesenteric veins) and the other urine leak (from a midportion of the medial ureter without compromising the bladder patch) after the transplants; both were successfully managed and the patients demonstrated immediate and sustained pancreas and kidney graft functions for 12 and 2 months posttransplantation. These cases illustrate the feasibility of combined pancreas and en bloc kidney transplantation from very small pediatric donors using a bladder patch technique to avoid small ureteral anastomosis.
Subject(s)
Diabetes Mellitus, Type 1/surgery , Kidney Transplantation/methods , Organ Size , Pancreas Transplantation/methods , Tissue Donors , Uremia/surgery , Urinary Bladder/transplantation , Adult , Drainage , Feasibility Studies , Humans , Infant , Kidney Transplantation/adverse effects , Mesenteric Veins , Pancreas Transplantation/adverse effects , Splenic Vein , Treatment Outcome , Urinary Incontinence/etiology , Urinary Incontinence/therapy , Venous Thrombosis/etiology , Venous Thrombosis/therapyABSTRACT
Gas in the portal vein is a rare and often fatal condition in surgical patients. However, the presence of gas in the mesenteric and portal veins in association with abdominal trauma is a transient incidental finding that resolves spontaneously. We describe a young patient with Crohn's disease who suffered air embolism of the portal veins secondary to blunt abdominal trauma. The condition was clinically benign and resolved spontaneously. The pathogenesis is discussed and a review of the literature is provided.
Subject(s)
Abdominal Injuries/complications , Embolism, Air/etiology , Portal Vein , Wounds, Nonpenetrating/complications , Accidents, Traffic , Adult , Female , HumansABSTRACT
We analyzed the results of 55 patients who underwent split liver transplantation at our center between September 1996 and December 2008, 30 adults (54.5%) and 25 children (45.5%). Median follow-up was 12 years. Overall patient survival was 71%, adult 70% and pediatric 72%. Mean patient survival was 61.58 months, and mean graft survival was 44.35 months. Pediatric survival and pediatric graft survival after 1 and 5 years were 84% and 72% and 72% and 52.4%, respectively. Adult survival and adult graft survival after 1 and 5 years were 75% and 66.2% and 60.7% and 51.5%, respectively. Twelve patients required retransplantation, 6 for primary nonfunction, 3 for chronic rejection, and 3 for vascular complications. Blood groups of the recipient patients were: 34 O, 14 A, 7 B, and 0 AB. The use of split liver for adult and pediatric populations allows us to expand the cadaveric donor pool and has the potential to significantly reduce waiting list mortality, especially for certain blood groups.