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Multivisceral Transplantation for Diffuse Portomesenteric Thrombosis: Lessons Learned for Surgical Optimization
Emilio Canovai1,2,3, Laurens J Ceulemans1,4,5, Nicholas Gilbo1,2,3
1Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, Leuven, Belgium.
Frontiers in Surgery
|March 8, 2021
Summary
Multivisceral transplantation offers a life-saving solution for diffuse portomesenteric thrombosis. A novel surgical approach minimizes blood loss and improves survival in these complex cases.
Area of Science:
- Transplantation Surgery
- Vascular Surgery
- Gastroenterology
Background:
- Diffuse portomesenteric thrombosis (DPT) causes severe complications including gastrointestinal bleeding and organ failure.
- Multivisceral transplantation (MVTx) is the only definitive treatment for DPT by replacing the entire portal system.
- MVTx for DPT presents significant technical challenges.
Purpose of the Study:
- To describe the institutional experience with MVTx for DPT.
- To highlight surgical challenges and propose technical solutions.
- To evaluate outcomes and survival rates.
Main Methods:
- Retrospective analysis of patients undergoing MVTx for DPT (2000-2020).
- Review of donor/recipient demographics and surgical strategies.
- Analysis of posttransplant complications and survival.
Main Results:
- Five patients underwent MVTx for DPT with life-threatening variceal bleeding.
- A combined technique of embolization and staged extraction minimized perioperative blood loss (median 3 RBC units transfused).
- No perioperative deaths; 4 of 5 patients survived with a median follow-up of 4.1 years.
Conclusions:
- MVTx is a viable option for DPT when other treatments fail.
- A standardized surgical approach can mitigate operative risks.
- This approach improves outcomes for patients with diffuse portomesenteric thrombosis.
