7. One Hundred Multivisceral Transplants (MVTx) At A Single Center
Andreas G. Tzakis, MD, PhD1, Tomoaki Kato, MD*1, Seigo Nishida, MD, PhD*1, David Levi, MD*1, Juan Madariaga, MD*1, John F. Thompson, MD*1, Gennaro Selvaggi, MD*1, Jang I. Moon, MD*1, Sony Tuteja, PharmD*1, G. Patricia Cantwell, MD*2
1University of Miami, Miami, FL; 2Nova Southeastern University, Ft. Lauderdale, FL
To describe the evolution of MVTx at a single center.
Retrospective analysis of 100 MVTx performed in 93 patients. All patients had transplantation of the stomach, pancreas and small intestine; some also had transplantation of the liver (n=79), kidney (n=12), large intestine (n=20) and spleen (n=26)). Primary indications included gastroschisis, volvulus, necrotizing enterocolitis in children, trauma and visceral thrombosis in adults.
Maintenance immunosuppression was with tacrolimus. Induction therapy, originally steroids or OKT3, currently consists of alemtuzumab in adults and daclizumab in children.
Evolution in surgical technique includes rapid dearterialization of the native viscera in order to reduce blood loss and operative time, routine use of the infrarenal aorta for arterialization, and preservation of the rim of the native stomach for anastamosis, avoiding postoperative reflux. A vascularized abdominal wall graft facilitated abdominal closure in 12 cases.
Main complications and survival are shown in table 1.
Intestinal rejection was the most common complication. Severe rejections were less frequent in MVT than isolated intestinal transplants.
Survival improved significantly in the latter part of our experience . Most of the survivors (43/50) are maintained totally on enteral nutrition. Six patients require intermittent IV hydration and 1 patient requires supplementary parenteral nutrition due to malabsorption.
Results are enhanced with new techniques. MVT is now an effective treatment for a variety of massive abdominal catastrophes.
|Graft vs Host Disease||n=4|
|Survival||One-Year Survival||Three-Year Survival|
|Overall||66 +/- 5%||53 +/- 6%|
|Before 2001 (n=34)||50 +/- 9%*||35 +/- 8%**|
|After 2001 (n=59)||75 +/- 6%*||67 +/- 7%**|