Small bowel transplant combined with a reduced auxiliary liver graft

Total parenteral nutrition (TPN) is the last choice to provide adequate nutritional status and improve life support for patients with intestinal failure. Although home parenteral nutrition (HPN) has allowed many patients to survive intestinal failure with good quality of life, it is not free from severe and even fatal complications including catheter sepsis, severe cholestasis, and chronic secondary hepatopathy. The association of chronic liver disease and intestinal failure has led many institutions to combine small bowel transplantation (SBT) with orthotopic liver transplantation (OLT), with patient and graft life survivals of 76% and 60% at the end of the first year, respectively. In cases of chronic liver failure or severe cholestasis associated with intestinal failure, we propose a new model in which an orthotopic small bowel allograft is combined with an auxiliary heterotopic reduced liver allograft, avoiding the risky total hepatectomy of the OLT and allowing the potential recovery of the native liver.