Multivisceral Transplantation for Diffuse Portomesenteric Thrombosis: Lessons Learned for Surgical Optimization

embolisation (therapeutic); intestinal transplantation; multivisceral transplantation; portomesenteric and splenic venous thrombosis; surgical technical improvement

Abstract :

[en] Background: Multivisceral transplantation entails the en-bloc transplantation of stomach, duodenum, pancreas, liver and bowel following resection of the native organs. Diffuse portomesenteric thrombosis, defined as the complete occlusion of the portal system, can lead to life-threatening gastrointestinal bleeding, malnutrition and can be associated with liver and intestinal failure. Multivisceral transplantation is the only procedure that offers a definitive solution by completely replacing the portal system. However, this procedure is technically challenging in this setting. The aim of this study is to describe our experience, highlight the challenges and propose technical solutions. Materials and Methods: We performed a retrospective analysis of our cohort undergoing multivisceral transplantation for diffuse portomesenteric thrombosis at our institution from 2000 to 2020. Donor and recipient demographics and surgical strategies were reviewed in detail and posttransplant complications and survival were analyzed. Results: Five patients underwent MVTx. Median age was 47 years (23–62). All had diffuse portomesenteric thrombosis with life-threatening variceal bleeding. Major blood loss during exenteration was avoided by combining two techniques: embolization of the native organs followed by a novel, staged extraction. This prevented major perioperative blood loss [median intra-operative transfusion of 3 packed red blood cell units (0–5)]. Median CIT was 330 min (316–416). There was no perioperative death. One patient died due to invasive aspergillosis. Four others are alive and well with a median follow-up of 4.1 years (0.3–5.9). Conclusions: Multivisceral transplantation should be considered in patients with diffuse portomesenteric thrombosis that cannot be treated by any other means. We propose a standardized surgical approach to limit the operative risk and improve the outcome. © Copyright © 2021 Canovai, Ceulemans, Gilbo, Duchateau, De Hertogh, Hiele, Jochmans, Vanuytsel, Maleux, Verhaegen, Monbaliu and Pirenne.

Disciplines :

Surgery

Author, co-author :

Canovai, Emilio; Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, Leuven, Belgium ; Department of Abdominal Transplant Surgery and Transplant Coordination, University Hospitals Leuven, Leuven, Belgium

Ceulemans, Laurens J; Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, Leuven, Belgium ; Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Chronic Diseases, Metabolism and Ageing, Katholieke Universiteit Leuven, Leuven, Belgium ; Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium

Gilbo, NICHOLAS ; Université de Liège - ULiège > Département des sciences cliniques > Pathologie chirurgicale abdominale et endocrinienne ; Centre Hospitalier Universitaire de Liège - CHU > > Service de chirurgie abdo, sénologique, endocrine et de transplantation

Duchateau, Nicolas M; Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, Leuven, Belgium ; Department of Abdominal Transplant Surgery and Transplant Coordination, University Hospitals Leuven, Leuven, Belgium

De Hertogh, Gert; Department of Pathology, University Hospitals Leuven, Leuven, Belgium

Hiele, Martin; Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium

Jochmans, Ina; Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, Leuven, Belgium ; Department of Abdominal Transplant Surgery and Transplant Coordination, University Hospitals Leuven, Leuven, Belgium

Vanuytsel, Tim; Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium

Maleux, Geert; Department of Radiology, University Hospitals Leuven, Leuven, Belgium

Verhaegen, Marleen; Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium

Monbaliu, Diethard; Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, Leuven, Belgium ; Department of Abdominal Transplant Surgery and Transplant Coordination, University Hospitals Leuven, Leuven, Belgium

Pirenne, Jacques; Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, Leuven, Belgium ; Department of Abdominal Transplant Surgery and Transplant Coordination, University Hospitals Leuven, Leuven, Belgium

Language :

English

Title :

Multivisceral Transplantation for Diffuse Portomesenteric Thrombosis: Lessons Learned for Surgical Optimization

Publication date :

2021

Journal title :

Frontiers in Surgery

eISSN :

2296-875X

Publisher :

Frontiers Media S.A.

Volume :

Peer reviewed :

Peer Reviewed verified by ORBi

Available on ORBi :

since 25 January 2024

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