Noncomposite simultaneous liver and intestinal transplantation.

Patients with short-gut syndrome may develop total parenteral nutrition-associated liver disease, which may preclude them from isolated intestinal transplantation and require combined liver and intestinal transplantation. Traditionally, these multiorgan transplantations are performed using en bloc liver and intestinal grafts that share portal, hepatic, and mesenteric blood supplies. In the event that severe intestinal rejection occurs, it is prohibitive in these cases to remove the intestinal portion of the graft. Herein we present the case of a patient with short-gut syndrome caused by volvulus and severe cholestatic liver disease who underwent simultaneous intestinal and liver transplantation using separate grafts from the same cadaveric donor. We discuss the technical aspects of the case and the benefit of such an approach.