Intestinal and Multivisceral Transplantation

Excerpt

Multivisceral transplantation (MVT) can be categorized into many different organ combinations, but for this review, the focus will be on concurrent transplantation of the intestine, stomach, hepatobiliary system, and the pancreaticoduodenal complex – which can also be performed in a modified fashion by “cherry-picking” different organs that suit the recipient’s condition. Some approach MVT by the replacement of any organ that relies on the superior mesenteric and celiac artery. The concept of a total multi-visceral abdominal transplant was introduced in 1960 by the father of modern transplantation – Thomas Starzl.

Originally performed on dogs to study the effects of mass denervation of homografts, the concept was not abandoned, and in the 80’s it was attempted again, but this time on humans. Unfortunately, the first patient suffered post-operative hemorrhage; the following two developed posttransplant lymphoproliferative disorder (PTLD) and never left the hospital. The first hospital discharge MVT was performed in December of 1989. The patient was able to survive 10 months without parenteral support and ultimately passed from metastatic pancreatic cancer. To date since 1988, there have been 1,916 intestinal transplantations combined with other organs, most commonly liver-intestine-pancreas (1,105) – with the second most common being liver-intestine (464). With advancements in immunosuppression and post-operative care, the 1-year survival rate has increased from approximately 40% to over 80% since the 1990s, with 5-year survival being around 60%.