Small-for-size syndrome does not occur in intestinal transplantation without liver containing grafts

ABSTRACTBackgroundThe ideal donor in intestinal transplantation is generally considered to be 50 – 70% of recipient body weight. This may be due to concerns for "small for size" syndrome as seen in liver transplantation. We report our experience using smaller donors (donor-recipient weight ratio, DRWR 50%. We examined patient and graft survival and enteral autonomy from parenteral nutrition as surrogate markers for safety of using smaller donors and ease of abdominal wall closure between groups to determine the value.ResultsThere was no difference in overall patient and graft survival, time to enteral autonomy from parenteral nutrition and weight gain after ITX over time between groups. Need for complicated abdominal closure techniques were significantly more frequent in the control group than in the study group (34.6% versus 6.9%, p = 0.01). Secondary abdominal closure occurred more frequently in the control group (15.4% versus 0%, p = 0.014). Wound revisions also occurred more frequently in the control group (15.4% versus 0%, p = 0.028).ConclusionsOur data suggest that ITX using smaller donors (DRWR ≤ 50%) seems to be an acceptable practice without adverse impact on surgical complications, nutritional autonomy, and patient and graft survival. Abdominal wall closure seems easier in recipients of smaller donors and 'small for size' syndrome as described in liver transplantation does not occur with intestinal allografts. Background The ideal donor in intestinal transplantation is generally considered to be 50 – 70% of recipient body weight. This may be due to concerns for "small for size" syndrome as seen in liver transplantation. We report our experience using smaller donors (donor-recipient weight ratio, DRWR 50%. We examined patient and graft survival and enteral autonomy from parenteral nutrition as surrogate markers for safety of using smaller donors and ease of abdominal wall closure between groups to determine the value. Results There was no difference in overall patient and graft survival, time to enteral autonomy from parenteral nutrition and weight gain after ITX over time between groups. Need for complicated abdominal closure techniques were significantly more frequent in the control group than in the study group (34.6% versus 6.9%, p = 0.01). Secondary abdominal closure occurred more frequently in the control group (15.4% versus 0%, p = 0.014). Wound revisions also occurred more frequently in the control group (15.4% versus 0%, p = 0.028). Conclusions Our data suggest that ITX using smaller donors (DRWR ≤ 50%) seems to be an acceptable practice without adverse impact on surgical complications, nutritional autonomy, and patient and graft survival. Abdominal wall closure seems easier in recipients of smaller donors and 'small for size' syndrome as described in liver transplantation does not occur with intestinal allografts. CORRESPONDENCE: Jang I Moon, One Gustave L. Levy Place, Box 1104. New York, NY 10029–6574. jang.moon@mountsinai.org AUTHORSHIP Jang Moon: Participated in research design, data collection, statistical analysis and composing manuscript. Thomas D Schiano: Participated in research design and reviewing data. Alyssa Burnham: Participated in data collection. Kwai Lam: Participated in data collection. Kishore R Iyer: Participated in research design, reviewing data and composing manuscript. DISCLOSURE The authors declare no conflicts of interests. FUNDING This study does not have funding support. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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