Piggyback orthotopic intestinal transplantation.

PORTAL, as opposed to systemic, venous drainage from small intestinal allografts is thought to be preferable because it provides unquestionable physiologic (1-3) and hypothetic, but unverified (4,5) immunologic advantages. However, in clinical instances, it may be difficult to find a place on the recipient portal or superior mesenteric vein (SMV) where the donor portal vein can be anastomosed. We encountered this problem in two most recent solitary intestinal transplants. One patient was an adult with 15 previous abdominal operations and the other was a child with only one earlier laparotomy. The abdomen was entered through an upper transverse incision. Because of multiple adhesions, the recipient SMV could not be adequately