Presently, most centers would transplant a liver and bowel that has an intact mesenteric-portal circulatory system en bloc. Therefore, the entire duodenum with a rim of pancreas is left with the graft. Because all the other upper abdominal organs such as the stomach, pancreas, spleen and duodenum are left in place, a portocaval shunt has to be created in order to provide venous drainage for these organs. This technique makes reconstruction of the biliary system unnecessary. Both grafts, however, can be transplant ed simultaneously but not as a composite graft. Combined liver-intestinal transplantation is performed in patients with intestinal failure together with liver damage (considered irreversible), usually due to parenteral nutrition. Severe fibrosis on histology with bilirubin of more than 10 mg/dl may indicate a point of no recovery for liver function.
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