Novel Technique of In-Situ Reduction of a Deceased Donor Small Intestine Graft to Improve Access in Donor–Recipient Mismatch

Small intestine transplantation remains a complex but definitive treatment for patients with irreversible intestinal failure, particularly in settings where parenteral nutrition (PN) services are limited. One of the critical challenges is achieving size compatibility between the donor organ and the recipient's abdominal domain. We describe a 50-year-old man, 160 cm in height and 65 kg in weight (body mass index [BMI] 25.3 kg/m2), who suffered from massive bowel gangrene due to thrombosis. He underwent resection of the entire small bowel 10 cm distal to the duodenojejunal (DJ) flexure. He had two episodes of central venous line-related sepsis, multiple hospital admissions, and lost 30 kg in 2 months. He underwent a novel technique of in-situ reduction of a deceased donor intestinal graft, based on the principles of living donor intestinal transplant (LDIT), wherein approximately 200 cm of the distal ileum was retrieved. The patient was extubated on the table and discharged with stable graft function. Regular follow-up for 3 months was uneventful. Recipients of other organs were stable at discharge. The success of this case highlights the technique’s feasibility, safety, and effectiveness. This innovative strategy could substantially expand the donor pool, particularly in resource-limited settings where paediatric or size-matched donors are scarce.