OBJECTIVE: To evaluate the clinical outcomes of multivisceral transplantation (MVT) in the setting of diffuse thrombosis of the portomesenteric venous system. BACKGROUND: Liver transplantation (LT) in the face of cirrhosis and diffuse portomesenteric thrombosis (PMT) is controversial and contraindicated in many transplant centers. LT using alternative techniques such as portocaval hemitransposition fails to eliminate complications of portal hypertension. MVT replaces the liver and the thrombosed portomesenteric system. METHODS: A database of intestinal transplant patients was maintained with prospective analysis of outcomes. The diagnosis of diffuse PMT was established with dual-phase abdominal computed tomography or magnetic resonance imaging with venous reconstruction. RESULTS: Twenty-five patients with grade IV PMT received 25 MVT. Eleven patients underwent simultaneous cadaveric kidney transplantation. Biopsy-proven acute cellular rejection was noted in 5 recipients, which was treated successfully. With a median follow-up of 2.8 years, patient and graft survival were 80%, 72%, and 72% at 1, 3, and 5 years, respectively. To date, all survivors have good graft function without any signs of residual/recurrent features of portal hypertension. CONCLUSIONS: MVT can be considered as an option for the treatment of patients with diffuse PMT. MVT is the only procedure that completely reverses portal hypertension and addresses the primary disease while achieving superior survival results in comparison to the alternative options.
OBJECTIVE: To evaluate the clinical outcomes of multivisceral transplantation (MVT) in the setting of diffuse thrombosis of the portomesenteric venous system. BACKGROUND: Liver transplantation (LT) in the face of cirrhosis and diffuse portomesenteric thrombosis (PMT) is controversial and contraindicated in many transplant centers. LT using alternative techniques such as portocaval hemitransposition fails to eliminate complications of portal hypertension. MVT replaces the liver and the thrombosed portomesenteric system. METHODS: A database of intestinal transplant patients was maintained with prospective analysis of outcomes. The diagnosis of diffuse PMT was established with dual-phase abdominal computed tomography or magnetic resonance imaging with venous reconstruction. RESULTS: Twenty-five patients with grade IV PMT received 25 MVT. Eleven patients underwent simultaneous cadaveric kidney transplantation. Biopsy-proven acute cellular rejection was noted in 5 recipients, which was treated successfully. With a median follow-up of 2.8 years, patient and graft survival were 80%, 72%, and 72% at 1, 3, and 5 years, respectively. To date, all survivors have good graft function without any signs of residual/recurrent features of portal hypertension. CONCLUSIONS: MVT can be considered as an option for the treatment of patients with diffuse PMT. MVT is the only procedure that completely reverses portal hypertension and addresses the primary disease while achieving superior survival results in comparison to the alternative options.
Authors: Damian J Harding; M Thamara P R Perera; Frederick Chen; Simon Olliff; Dhiraj Tripathi Journal: World J Gastroenterol Date: 2015-06-14 Impact factor: 5.742
Authors: Ahmed M Elsabbagh; Jason Hawksworth; Khalid M Khan; Stuart S Kaufman; Nada A Yazigi; Alexander Kroemer; Coleman Smith; Thomas M Fishbein; Cal S Matsumoto Journal: Am J Transplant Date: 2019-03-26 Impact factor: 8.086
Authors: Sérgio Paiva Meira Filho; Bianca Della Guardia; Andréia Silva Evangelista; Celso Eduardo Lourenço Matielo; Douglas Bastos Neves; Fernando Luis Pandullo; Guilherme Eduardo Gonçalves Felga; Jefferson André da Silva Alves; Lilian Amorim Curvelo; Luiz Gustavo Guedes Diaz; Marcela Balbo Rusi; Marcelo de Melo Viveiros; Marcio Dias de Almeida; Marina Gabrielle Epstein; Pamella Tung Pedroso; Paolo Salvalaggio; Roberto Ferreira Meirelles Júnior; Rodrigo Andrey Rocco; Samira Scalso de Almeida; Marcelo Bruno de Rezende Journal: Einstein (Sao Paulo) Date: 2015 Jan-Mar
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