Abdominal multivisceral transplantation

Abstract

Under FK506-based immunosuppression, 13 abdominal multivisceral transplantations were performed in 6 children and 7 adults. Of the 13 recipients, 7 (53.8%) are alive and well with functioning grafts after 9 to 31 months. Six recipients died: three from PTLD, one from rejection, one from sepsis, and one from respiratory failure. In addition to rejection, postoperative complications occurring in more than isolated cases included PTLD (n = 6), abdominal abscess formation (n = 5), pancreatitis (n = 3), and ampullary dysfunction (n = 2). In addition, infection by enteric microorganisms was common during the early postoperative period. Currently, all 7 survivors are on an oral diet and have normal liver function. Two recipients (one insulin-dependent) require antidiabetes treatment, in one case following distal pancreatectomy and in the other after two episodes of pancreatic rejection. Thus, abdominal multivisceral transplantation is a difficult but feasible operation that demands complex and prolonged posttransplantation management. It is not yet ready for application and awaits a better strategy of immune modulation.

Figure 1

Scheme of multivisceral transplantation: (A) Multiviscerai transplantation without colon; (B) Multivisceral transplantation with colon; (C) Multivisceral transplantation without liver and with rectal reconstruction by a pull-through technique; (D) Multivisceral transplantation with bilateral kidneys.

Figure 2

Immunosuppression and liver and kidney function. Values expressed as median. (A) Pediatric patients; (B) Adult patients.

Figure 3

Blood level of glucose and C-peptide after intravenous glucose tolerance test. Glucose was given at a dose of 0.5 mg/kg. Shaded areas indicate range obtained from 5 normal controls. POD: postoperative days.

Figure 4

Barium follow-through of multivisceral recipient (patient 10). (A) 30 min; (B) 2 hr; (C) 3 hr; (D) 4 hr.