Details

Autor(en) / Beteiligte

• Sharkey, Lisa Mary, MA MB BChir MRCP
• Russell, Neil Kenneth, BSc(Hons) MB BChir MChir FRCS
• Rutter, Charlotte S., BSc(Hons) MBChB
• Middleton, Stephen J., MB BS MA MD FRCP
• Bradley, J Andrew, PhD FRCS FMedSci
• Jamieson, Neville V., MA MB BS MD FRCS FHEA
• Butler, Andrew J., MA MB BChir MChir FRCS

Titel

Urgent Multivisceral Transplant for Widespread Splanchnic Ischemia

Ist Teil von

• Journal of the American College of Surgeons, 2015

Erscheinungsjahr

2015

Beschreibungen/Notizen

• Abstract Background Multivisceral transplantation (transplantation of the stomach, intestine, liver, and pancreas) is usually undertaken as a semi-elective procedure after thorough assessment in patients who have intestinal failure with cirrhosis, cirrhosis with portomesenteric venous thrombosis or tumours such as desmoids involving the liver and mesentery. Study Design Data was collected prospectively from the time of referral and held in a central database. This was used to here report the first cases of urgent Multivisceral transplantation (MVT) in patients with widespread splanchnic ischemia (occlusion of the celiac axis and superior mesenteric artery) resulting in small bowel infarction and hepatic failure. Results Three females (aged 33, 48 and 50 years) were referred to our center with superior mesenteric artery and celiac axis occlusion. All other modes of treatment had been considered and/or attempted. Following transfer to our institution, all patients were assessed, urgently listed and transplanted in 10, 7 and 5 days. Two patients are still alive after 2 years and one died at 8 months from multiorgan failure due to infections and graft versus host disease. Conclusion Treatment options for patients presenting with widespread splanchnic ischemia with hepatic and intestinal failure/infarction were previously limited to salvage surgery and attempted revascularization. In situations where these failed the only previous option would have been palliation. In selected cases, we propose that urgent Multivisceral transplantation should be considered as a life-saving treatment. This represents a previously unreported indication for MVT.