Modified 'liver-sparing' multivisceral transplant with preserved native spleen, pancreas, and duodenum: technique and long-term outcome
| Autor: | Guosheng Wu, William Stein, Kareem Abu-Elmagd, George V. Mazariegos, John McMichael, Guilherme Costa, Geoffrey Bond, Kyle Soltys, Ruy J. Cruz, L Martin, Rakesh Sindhi, Darlene Koritsky |
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| Rok vydání: | 2010 |
| Předmět: |
Adult
Graft Rejection Male medicine.medical_specialty Adolescent Duodenum medicine.medical_treatment Graft vs Host Disease Spleen Pancreas transplantation Pseudo obstruction Young Adult Postoperative Complications medicine Humans Transplantation Homologous Child Aged Postoperative Care integumentary system Graft rejection business.industry Stomach Gastroenterology Infant Middle Aged Lymphoproliferative Disorders Surgery Transplantation Intestines Survival Rate Viscera medicine.anatomical_structure Child Preschool Tissue and Organ Harvesting Female Pancreas Transplantation Pancreas Living donor liver transplantation business |
| Zdroj: | Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 14(11) |
| ISSN: | 1873-4626 |
| Popis: | 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.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.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.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. |
| Databáze: | OpenAIRE |
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