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Introduction:
Multivisceral transplantation (MVT) includes the simultaneous transplantation of multiple abdominal viscera including the stomach, duodenum, pancreas and small intestine, with (MVT) or without the liver (Modified MVT or 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 multivisceral transplants 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 laboratory values and serial endoscopy with biopsy.
Results:
During the study period, 92 patients received 100 transplants including 85 MVT and 15 MMVT. There were 19 patients who received a simultaneous kidney graft. There were 24 pediatric and 76 adult recipients (range 4 months to 66 years). Indications included short gut with liver failure, cirrhosis with 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 follow-up of 36 months, 1-, 3- and 5-year graft survival is 75%, 64% and 64%. There was a learning curve with this complex procedure resulting in a 50% patient survival during the period from 2004 to 2007, followed by a 75% patient survival during the period from 2008 to 2010. Primary complications included rejection (45% MMVT and 15% MVT), infection (>90% in the first year), graft versus host disease and post-transplant lymphoproliferative disorder.
Conclusion:
Indications for MVT and MMVT have broadened to include patients with slow growing tumors, complete portomesenteric thrombosis and abdominal catastrophes not amenable to other surgical therapy. Outcomes continue to improve with many patients returning to full functional status and enjoying long-term survival.