[Multiple transplantation of abdominal organs]

Area of Science:

• Transplantation immunology
• Gastrointestinal surgery
• Immunosuppression

Background:

• Abdominal multivisceral transplantation, including liver, pancreas, and intestine, is increasingly successful.
• Graft-versus-host disease (GVHD) and organ rejection complicate these procedures due to the lymphoreticular component in grafts.

Purpose of the Study:

• To describe the principles of multivisceral transplantation and its derivatives.
• To propose an alternative approach to managing the lymphoreticular component in grafts to prevent GVHD and rejection.

Main Methods:

• Review of principles for procurement, preservation, and postoperative management in multivisceral transplantation.
• Application of potent immunosuppression, such as FK 506, to allow donor lymphoreticular cell circulation without GVHD.
• Observation of local chimerism where recipient cells repopulate the graft's lymphoreticular component, preventing rejection.

Main Results:

• Powerful immunosuppression with FK 506 enables donor lymphoreticular cells to circulate without causing clinical GVHD.
• Graft lymphoreticular cells become recipient-like (local chimerism), preventing rejection.
• Metabolic interrelations between grafted and recipient organs, particularly hepatotrophic factors like insulin, influence transplant outcomes.

Conclusions:

• Understanding immunologic and non-immunologic factors, alongside potent immunosuppression, will drive advancements in abdominal organ transplantation.
• This approach is crucial for overcoming previous challenges in hollow visceral transplantation.