Abdominal wall transplantation: surgical and immunologic aspects

Area of Science:

• Surgical Innovation
• Transplantation Medicine
• Immunology

Background:

• Abdominal wall defects often complicate intestinal or multivisceral transplantation.
• Reconstruction of the abdominal domain is critical for graft survival and patient recovery.
• Primary closure of the abdominal cavity can be technically challenging or impossible in complex cases.

Purpose of the Study:

• To present the combined experience and long-term follow-up of abdominal wall transplantation.
• To evaluate the feasibility and outcomes of abdominal wall allografts in conjunction with intestinal transplantation.
• To analyze graft survival, rejection episodes, and overall patient outcomes.

Main Methods:

• A retrospective review of 15 abdominal wall transplants from cadaveric donors in 14 patients.
• Vascular supply established via inferior epigastric vessels (iliac vessels or microsurgical technique).
• Immunosuppression protocol included alemtuzumab induction and tacrolimus monotherapy.

Main Results:

• Five patients remain alive with no deaths related to the abdominal wall transplant.
• Three episodes of abdominal wall graft rejection occurred, treated successfully with steroids.
• Abdominal wall and intestinal graft rejections were independent events.
• Two grafts were lost due to vascular thrombosis.

Conclusions:

• Abdominal wall transplantation is a viable option for patients requiring intestinal or multivisceral transplants.
• The technique is indicated when primary abdominal closure is not feasible.
• Independent rejection of abdominal wall and visceral grafts suggests distinct immunological responses.