Modified multivisceral transplantation with splenopancreatic preservation

A common requirement of multivisceral transplantation has been removal of the native duodenum, pancreas and spleen in the process of abdominal exenteration. Oftentimes, though, the indication for their removal has not been underlying disease states in those organs. In order to avoid adverse sequelae of pancreas and splenic removal for purely anatomic reasons, we have designed a new approach and have performed a multivisceral transplantation with splenopancreatic preservation. In this modified multivisceral technique, the native spleen and pancreas are preserved with venous outflow through a native portocaval shunt, and native pancreatic exocrine drainage is established to the donor jejunum. Risk of transplant pancreatic insufficiency, posttransplant lymphoproliferative disorder, and postsplenectomy sepsis may be avoided utilizing this technique. This new modification of multivisceral transplantation allows pancreaticosplenic preservation while facilitating stomach replacement for those patients requiring intestinal replacement therapy. It represents another step towards minimizing morbidities associated with these lifesaving transplants.