The Miami experience with almost 100 multivisceral transplants

Area of Science:

• Abdominal Surgery
• Transplantation Medicine
• Immunosuppression Therapy

Background:

• Multivisceral transplantation (MVT) is a complex procedure for patients with extensive abdominal pathologies.
• Outcomes have historically been limited by surgical challenges, rejection, and infection.
• Advancements in medical and surgical fields are crucial for improving MVT success rates.

Purpose of the Study:

• To evaluate the outcomes of primary multivisceral transplantations over time.
• To analyze the impact of evolving surgical techniques, immunosuppression, and monitoring on patient survival and rejection rates.
• To establish the current indications and long-term viability of MVT.

Main Methods:

• Retrospective analysis of 98 patients undergoing primary multivisceral transplantation.
• Categorization into three eras based on chronological evolution of treatment protocols (1994-2000s).
• Assessment of patient survival, mortality causes, retransplantation rates, and rejection episodes.

Main Results:

• Overall 3-year survival improved from 25% in era 1 to 58% in era 3.
• Infection and rejection were leading causes of mortality.
• The third era showed significantly lower rates of moderate/severe rejection (31.6%) compared to earlier eras (67.6%), with MVT demonstrating a protective effect against severe rejection.

Conclusions:

• Multivisceral transplantation is a viable option for patients with short bowel syndrome and catastrophic abdominal conditions.
• Progress in surgical techniques, immunosuppression, and patient monitoring has markedly improved survival rates.
• Current MVT survival rates are comparable to other complex solid organ transplantations.