Background and Aim: Living donor small bowel transplantation (SBT) for intestinal failure patients has several potential advantages, including shorter waiting time and better HLA matching. However, clinical data are scarce on this unique cohort of organ donors and we report their short- and long-term outcomes.

Patients and Methods: The medical records of three adult donors for SBT performed at our institution between 2006 and 2011 were reviewed. All 3 children had Hirschsprung’s Disease [median age, 14 (range, 11-15) years].

Results: Donor median age, 48 (range, 40-48) years; male:female, 2:1; body mass index, 21.6 (20.1-29.6); body surface area, 1.66 (1.53-2.13). The length of the intestinal graft was 150 (110-150) cm and that of the remnant intestine was 350 (230-370) cm. All donors had 30-40 cm of their terminal ileum spared, leaving the ileocecal valve intact. The median operative time was 5:52 (3.56-5:55) with minimal bleeding. Donor 1 initially presented with a body weight of 103 kg and a body mass index of 32.5 together with a fatty liver (with normal liver enzymes) radiologically: he successfully lost weight upon our recommendation and his body mass index declined to 29.6 at transplantation. Unfortunately, he developed adhesive ileus postoperatively and experienced a prolonged hospital stay of about 2 months. Donors 1 and 2 had a history of tobacco use and social drinking and instructions for smoking cessation were given prior to surgery. No postoperative complications were encountered in donors 2 and 3. The median follow-up period was 48 months. Donor 1 never suffered ileus thereafter and none of the donors experienced late gastrointestinal problems, such as persistent diarrhea, weight loss, or lipid/vitamin malabsorption. However, donor 1 started showing mild elevation of liver enzymes more than 3 years after surgery. All 3 recipients are currently alive with functioning grafts.

Conclusions: Our limited experience revealed promising results of living donor SBT for children with intestinal failure. The donor operation can be performed safely in general; however, meticulous perioperative management is of paramount importance to minimize morbidity.