CPT® Code 44720

1. Indications

The backbench reconstruction of a cadaver or living donor intestinal allograft, as described by CPT® Code 44720, is indicated for patients requiring intestinal transplantation due to various conditions that compromise the function of their intestines. These indications may include, but are not limited to, the following:

• Intestinal Failure - A condition where the intestines are unable to absorb nutrients adequately, leading to malnutrition and other complications.
• Short Bowel Syndrome - A disorder that occurs when a significant portion of the small intestine is missing or has been removed, resulting in severe malabsorption.
• Congenital Anomalies - Birth defects affecting the structure of the intestines that may necessitate transplantation.
• Inflammatory Bowel Disease - Severe cases of Crohn's disease or ulcerative colitis that do not respond to medical management and require surgical intervention.

2. Procedure

The procedure for backbench reconstruction of the intestinal allograft involves several critical steps to ensure the allograft is properly prepared for transplantation. Each step is essential for the successful outcome of the procedure.

• Step 1: Procurement and Preservation The intestinal allograft is procured from either a cadaver donor or a living compatible donor. Upon procurement, the allograft is immediately placed on ice and bathed in a cold preservation solution. This step is crucial to maintain the viability of the tissue until it can be surgically prepared.
• Step 2: Venous Anastomosis The next step involves the surgical connection of the superior mesenteric vein, which is attached to the intestinal allograft, to an extension venous graft. This is performed in an end-to-end fashion, ensuring that blood flow can be effectively established once the allograft is transplanted. The meticulous suturing technique is vital for the success of the anastomosis.
• Step 3: Additional Grafts If the surgical team determines that additional venous extension grafts are necessary to achieve optimal blood flow, each of these grafts is reported separately. This step highlights the individualized nature of the procedure, as the need for additional grafts may vary based on the specific anatomical and physiological considerations of the donor and recipient.

3. Post-Procedure

After the completion of the backbench reconstruction, the allograft is prepared for transplantation into the recipient. Post-procedure care includes monitoring for any complications related to the anastomosis, such as thrombosis or leakage. The surgical team will also ensure that the allograft remains in optimal condition until the transplantation occurs. Close observation of the graft's viability and the recipient's overall health is essential during this period to facilitate a successful transplant outcome.