Basic considerations for the procurement of intestinal grafts.

From May 1990 to September 1993.59 patients received intestinal transplantation at our center. Twenty-two required an isolated intestinal (small bowel (S8]) graft. 26 required a combined liver and intestinal (SBIL) graft. and II required a multiviscerai (MV) graft. Three additional grafts were obtained for S8 (n = I). S81L (n = I). and MV (n '" I) retransplantation. AU 62 grafts were obtained from A80 blood type-identical cadaveric donors of slightly larger size (57% of adults and 37% of children) or smaller size (43% of adults and 63% of children). The Iymphocytotoxic cross-match was strongly positive in four patients who were successfully transplanted. No attempts were made to alter the graft Iymphoreticular tissue with antilymphocyte preparation or other modalities. Recently, a cytomegalovirus (CMV) seropositive donor was avoided for a CMV-seronegative recipient in isolated intestinal transplantation because of a high incidence of CMV enteritis. Gut decontamination with amphotericin B. ami· noglycosides. and polymyxin E. as well as intravenous antibiotics with ampicillin and cefotaximC\' were administered preand intraoperatively for all donors. University of Wisconsin IUW) solution was used for in situ perfusion and simple cold storage of the entire graft. The total volume of UW solution used for in situ perfusion was I 10 2 L for adult donors and 50 to IIlO mUkg for pediatric Jonors. Lummal Hushing with antimicrobial agents used for gut Jecontammation became a standard procedure when the colon was procured as a part of the intestinal graft. The logistics of the operative procedure have been described previously. 1·.1