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

6Citations
Citations of this article
30Readers
Mendeley users who have this article in their library.

Abstract

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.

References Powered by Scopus

Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey

25722Citations
N/AReaders
Get full text

Portal vein thrombosis in adults undergoing liver transplantation: Risk factors, screening, management, and outcome

593Citations
N/AReaders
Get full text

Early and late complications associated with transcatheter occlusion of secundum atrial septal defect

548Citations
N/AReaders
Get full text

Cited by Powered by Scopus

Alternative forms of portal vein revascularization in liver transplant recipients with complex portal vein thrombosis

14Citations
N/AReaders
Get full text

From intestinal failure to transplantation: Review on the current need for transplant indications under multidisciplinary transplant programs worldwide

2Citations
N/AReaders
Get full text

Innovative surgical techniques in the intestine and multivisceral transplant

0Citations
N/AReaders
Get full text

Register to see more suggestions

Mendeley helps you to discover research relevant for your work.

Already have an account?

Cite

CITATION STYLE

APA

Canovai, E., Ceulemans, L. J., Gilbo, N., Duchateau, N. M., De Hertogh, G., Hiele, M., … Pirenne, J. (2021). Multivisceral Transplantation for Diffuse Portomesenteric Thrombosis: Lessons Learned for Surgical Optimization. Frontiers in Surgery, 8. https://doi.org/10.3389/fsurg.2021.645302

Readers' Seniority

Tooltip

Researcher 13

72%

PhD / Post grad / Masters / Doc 5

28%

Readers' Discipline

Tooltip

Medicine and Dentistry 16

80%

Economics, Econometrics and Finance 2

10%

Agricultural and Biological Sciences 1

5%

Pharmacology, Toxicology and Pharmaceut... 1

5%

Save time finding and organizing research with Mendeley

Sign up for free