Multivisceral Transplantation: Expanding Indications and Improving Outcomes

Richard Mangus, A. Joseph Tector, Chandrashekhar A. Kubal, Jonathan A. Fridell, Rodrigo M. Vianna

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

Introduction: Multivisceral transplantation includes the simultaneous transplantation of multiple abdominal viscera including the stomach, duodenum, pancreas, and small intestine, with (multivisceral transplant, MVT) or without the liver (modified MVT, MMVT). This study reviews the changing indications and outcomes for this procedure over a 7-year period at a university medical center. Methods: This study is a retrospective case review of MVTs performed between 2004 and 2010 at a single center. All cases were either MVT or MMVT and included a simultaneous kidney transplant, if indicated. Graft failure was defined as loss of the graft or complete loss of function. Graft function was monitored by clinical function, laboratory values, and serial endoscopy with biopsy. Results: During the study period, 95 patients received 100 transplants including 84 MVT and 16 MMVT. There were 19 patients who received a simultaneous kidney graft. There were 24 pediatric and 76 adult recipients (range 7 months to 66 years). Indications included intestinal failure alone, intestinal failure with cirrhosis, complete portal mesenteric thrombosis, slow-growing central abdominal tumors, intestinal pseudoobstruction, and frozen abdomen. All patients received antibody-based induction immunosuppression with calcineurin inhibitor-based maintenance immunosuppression. At a median mortality adjusted follow-up of 25 months, 1- and 3-year patient survival is 72 % and 57 %. There was a learning curve with this complex procedure resulting in a 48 % patient survival during the period from 2004 to 2007, followed by a 70 % patient survival during the period from 2008 to 2010. Post-transplant complications included rejection (50 % MMVT and 17 % MVT), infection (>90 % first year), graft versus host disease (13 %), and post-transplant lymphoproliferative disorder (5 %). Conclusion: Indications for MVT and MMVT have broadened to include patients with terminal conditions not amenable to other medical therapies such as slow-growing tumors of the mesenteric root, complete portomesenteric thrombosis, and abdominal catastrophes/frozen abdomen. Outcomes have improved over time with many patients returning to full functional status and enjoying long-term survival.

Original languageEnglish
Pages (from-to)179-187
Number of pages9
JournalJournal of Gastrointestinal Surgery
Volume17
Issue number1
DOIs
StatePublished - 2013

Fingerprint

Transplantation
Transplants
Survival
Abdomen
Immunosuppression
Thrombosis
Intestinal Pseudo-Obstruction
Kidney
Learning Curve
Viscera
Lymphoproliferative Disorders
Graft vs Host Disease
Duodenum
Endoscopy
Small Intestine
Pancreas
Neoplasms
Stomach
Fibrosis
Maintenance

Keywords

  • Modified multivisceral transplant
  • Multivisceral transplant
  • Outcomes
  • Surgical indications

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Multivisceral Transplantation : Expanding Indications and Improving Outcomes. / Mangus, Richard; Tector, A. Joseph; Kubal, Chandrashekhar A.; Fridell, Jonathan A.; Vianna, Rodrigo M.

In: Journal of Gastrointestinal Surgery, Vol. 17, No. 1, 2013, p. 179-187.

Research output: Contribution to journalArticle

Mangus, Richard ; Tector, A. Joseph ; Kubal, Chandrashekhar A. ; Fridell, Jonathan A. ; Vianna, Rodrigo M. / Multivisceral Transplantation : Expanding Indications and Improving Outcomes. In: Journal of Gastrointestinal Surgery. 2013 ; Vol. 17, No. 1. pp. 179-187.
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AB - Introduction: Multivisceral transplantation includes the simultaneous transplantation of multiple abdominal viscera including the stomach, duodenum, pancreas, and small intestine, with (multivisceral transplant, MVT) or without the liver (modified MVT, MMVT). This study reviews the changing indications and outcomes for this procedure over a 7-year period at a university medical center. Methods: This study is a retrospective case review of MVTs performed between 2004 and 2010 at a single center. All cases were either MVT or MMVT and included a simultaneous kidney transplant, if indicated. Graft failure was defined as loss of the graft or complete loss of function. Graft function was monitored by clinical function, laboratory values, and serial endoscopy with biopsy. Results: During the study period, 95 patients received 100 transplants including 84 MVT and 16 MMVT. There were 19 patients who received a simultaneous kidney graft. There were 24 pediatric and 76 adult recipients (range 7 months to 66 years). Indications included intestinal failure alone, intestinal failure with cirrhosis, complete portal mesenteric thrombosis, slow-growing central abdominal tumors, intestinal pseudoobstruction, and frozen abdomen. All patients received antibody-based induction immunosuppression with calcineurin inhibitor-based maintenance immunosuppression. At a median mortality adjusted follow-up of 25 months, 1- and 3-year patient survival is 72 % and 57 %. There was a learning curve with this complex procedure resulting in a 48 % patient survival during the period from 2004 to 2007, followed by a 70 % patient survival during the period from 2008 to 2010. Post-transplant complications included rejection (50 % MMVT and 17 % MVT), infection (>90 % first year), graft versus host disease (13 %), and post-transplant lymphoproliferative disorder (5 %). Conclusion: Indications for MVT and MMVT have broadened to include patients with terminal conditions not amenable to other medical therapies such as slow-growing tumors of the mesenteric root, complete portomesenteric thrombosis, and abdominal catastrophes/frozen abdomen. Outcomes have improved over time with many patients returning to full functional status and enjoying long-term survival.

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