Pediatric living donor intestine transplant following an atypical complication of COVID-19: A unique case report from India
Pediatric living donor intestine transplant following an atypical complication of COVID-19: A unique case report from India
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DOI：
10.1111/ajt.16798
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发表时间：
2021-09-09
影响因子：
8.8
通讯作者：
Tambe, Shrinivas
中科院分区：
文献类型：
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作者：
Chaubal, Gaurav;Hatimi, Hunaid;Tambe, Shrinivas
冠状病毒病-19（COVID-19）感染导致严重的胃肠道并发症是罕见的。一名9岁儿童在从轻度COVID-19感染中恢复后，因上级肠系膜动脉血栓形成而发生小肠坏疽。他需要切除整个坏死小肠沿着盲肠引起超短肠综合征。对切除的标本进行的逆转录-聚合酶链反应（RT-PCR）对COVID-19呈阳性。患者接受个体化肠外营养3个月。使用患者父亲捐赠的200 cm回肠进行活体供体肠移植。移植物功能令人满意，未并发血栓形成、感染、潜伏COVID-19再激活或排斥反应。到术后第21天，他可以完全脱离肠外营养。捐献者恢复顺利。六个月的随访是令人满意的，孩子实现了完全的肠内自主性以及目标目标营养。与COVID-19感染相关的血栓形成现象可影响较大的血管样上级肠系膜动脉，导致小肠坏疽。从COVID-19中恢复3个月后可以安全地进行肠道移植，没有任何不良后果。需要进一步的研究来确定这种情况下小肠移植的最佳时机和安全性。
Coronavirus disease-19 (COVID-19) infection causing severe gastrointestinal complications is rare. A 9-year-old child after recovering from mild COVID-19 infection developed small bowel gangrene due to superior mesenteric artery thrombosis. He required resection of entire necrotic small bowel along with caecum causing ultra-short bowel syndrome. Reverse transcriptase-polymerase chain reaction (RT-PCR) done on the resected specimen was positive for COVID-19. He was maintained on individualized parenteral nutrition for 3 months. A living donor intestinal transplant was performed using 200 cm of ileum donated by the patient's father. The graft function was satisfactory and was not complicated with thrombosis, infection, reactivation of latent COVID-19 or rejection. He could be weaned off completely from parenteral nutrition by postoperative day 21. The donor had an uneventful recovery. Six month follow-up was satisfactory with the child achieving complete enteral autonomy as well as target goal nutrition. Thrombotic phenomena associated with COVID-19 infection can affect larger vessel-like superior mesenteric artery leading to small bowel gangrene. Intestine transplant could be done safely after 3 months of recovery from COVID-19 without any adverse outcomes. Further studies are required to establish optimal timing and safety of small bowel transplant in this situation.