BACKGROUND: Modification of the originally described multivisceral transplant operation was introduced at our institution 17 years ago. Donor liver was spared, and native spleen along with pancreaticoduodenal complex was preserved. METHODS: Thirty-six modified multivisceral grafts that include stomach, duodenum, pancreas, and intestine were given to 30 adults and six children. Leading causes of intestinal failure were pseudo-obstruction and Gardner's syndrome. Native spleen was preserved in 24 (67%) recipients along with pancreaticoduodenal complex in 18 (50%). Immunosuppression was tacrolimus-based, and recipient preconditioning was utilized in 80% of patients. RESULTS: Patient survival was 94% at 1 year and 75% at 5 years with graft survival of 91% and 51%; respectively. With mean follow-up of 51 ± 35 months, full nutritional autonomy was achieved in 89% of current survivors with no single example of disease recurrence. Preservation of native spleen was associated with increased survival and reduced risk of PTLD, life-threatening infections, and GVHD with no significant impact on graft loss due to rejection. Concomitant preservation of pancreaticoduodenal complex eliminated risks of biliary complications and glucose intolerance. CONCLUSION: Modified multivisceral transplantation with and without preservation of native spleen, pancreas, and duodenum is a valid therapeutic option for patients with diffuse gastrointestinal disorders and preserved hepatic functions.
BACKGROUND: Modification of the originally described multivisceral transplant operation was introduced at our institution 17 years ago. Donor liver was spared, and native spleen along with pancreaticoduodenal complex was preserved. METHODS: Thirty-six modified multivisceral grafts that include stomach, duodenum, pancreas, and intestine were given to 30 adults and six children. Leading causes of intestinal failure were pseudo-obstruction and Gardner's syndrome. Native spleen was preserved in 24 (67%) recipients along with pancreaticoduodenal complex in 18 (50%). Immunosuppression was tacrolimus-based, and recipient preconditioning was utilized in 80% of patients. RESULTS:Patient survival was 94% at 1 year and 75% at 5 years with graft survival of 91% and 51%; respectively. With mean follow-up of 51 ± 35 months, full nutritional autonomy was achieved in 89% of current survivors with no single example of disease recurrence. Preservation of native spleen was associated with increased survival and reduced risk of PTLD, life-threatening infections, and GVHD with no significant impact on graft loss due to rejection. Concomitant preservation of pancreaticoduodenal complex eliminated risks of biliary complications and glucose intolerance. CONCLUSION: Modified multivisceral transplantation with and without preservation of native spleen, pancreas, and duodenum is a valid therapeutic option for patients with diffuse gastrointestinal disorders and preserved hepatic functions.
Authors: S Todo; A Tzakis; K Abu-Elmagd; J Reyes; H Furukawa; B Nour; J Fung; A Demetris; T E Starzl Journal: Transplantation Date: 1995-01-27 Impact factor: 4.939
Authors: T E Starzl; M I Rowe; S Todo; R Jaffe; A Tzakis; A L Hoffman; C Esquivel; K A Porter; R Venkataramanan; L Makowka Journal: JAMA Date: 1989-03-10 Impact factor: 56.272
Authors: R G Lee; K Nakamura; A C Tsamandas; K Abu-Elmagd; H Furukawa; W R Hutson; J Reyes; J S Tabasco-Minguillan; S Todo; A J Demetris Journal: Gastroenterology Date: 1996-06 Impact factor: 22.682
Authors: K Abu-Elmagd; J Reyes; G Bond; G Mazariegos; T Wu; N Murase; R Sindhi; D Martin; J Colangelo; M Zak; D Janson; M Ezzelarab; I Dvorchik; M Parizhskaya; M Deutsch; A Demetris; J Fung; T E Starzl Journal: Ann Surg Date: 2001-09 Impact factor: 12.969
Authors: Andreas G Tzakis; Tomoaki Kato; David M Levi; Werviston Defaria; Gennaro Selvaggi; Debbie Weppler; Seigo Nishida; Jang Moon; Juan R Madariaga; Andre I David; Jeffrey J Gaynor; John Thompson; Erick Hernandez; Enrique Martinez; G Patricia Cantwell; Jeffrey S Augenstein; Anthony Gyamfi; Ernesto A Pretto; Lorraine Dowdy; Panagiotis Tryphonopoulos; Phillip Ruiz Journal: Ann Surg Date: 2005-10 Impact factor: 12.969
Authors: S Nikeghbalian; S H Mehdi; M Aliakbarian; K Kazemi; A Shamsaeefar; A Bahreini; M R Mansoorian; S A Malekhosseini Journal: Int J Organ Transplant Med Date: 2014