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SURGICAL TECHNIQUES Preparation for transplant Once the organ has been inspected and is deemed suitable for transplant it needs to be prepared for implantation. This is a crucial step and meticulous attention to detail and a systematic approach are vital to mi...

Transplantation procedure Pancreas transplant can be performed as an intraperitoneal or extraperitoneal procedure and the exocrine drainage of the pancreas can be managed by connection to the small intestine or urinary bladder ( Figure 90.3 ). The majority of...

Types of solid organ pancreas

transplant 1 Simultaneous pancreas–kidney transplant (SPK) . Both organs come from the same deceased donor. - This is the commonest type of pancreas transplant and is indicated in patients with chronic renal failure (on or close to requiring dialysis) seconda...

ABDOMINAL CLOSURE One of the most challenging parts of a multivisceral/intes tinal transplant is achieving abdominal closure. Multiple previous laparotomies and enterocutaneous fistulae can result in a rigid abdominal wall and loss of the abdominal domain esec...

ASSESSMENT FOR TRANSPLANTATION Assessment for a multivisceral/intestinal transplant requires a multidisciplinary approach, including: /uni25CF transplant surgeons; /uni25CF intestinal failure physicians; /uni25CF transplant anaesthetists; /uni25CF hepatologist...

BACKGROUND Intestinal and multivisceral transplantation can be a life-saving therapy for patients with complications from the treatment of intestinal failure. Indications for this highly specialised type of transplant are broadening to include acute vascular...

Early postoperative Many patients considered for multivisceral/intestinal trans - plantation have underlying prothrombotic tendencies. A defined prothrombotic disease may be characterised but a ombotic episodes without a history of multiple previous thr - spec...

FURTHER READING Abu-Elmagd K, Mazariegos G, Armanyous S et al . Five hundred - patients with gut malrotation: thirty years of experience with the introduction of a new surgical procedure. Ann Surg 2021; 274 (4): 581–96. Matsumoto CS, Subramanian S, Fishbein TM...

INDICATIONS FOR

Immunosuppression and rejection The rate of acute cellular rejection for intestinal grafts is higher than for any other abdominal organ. This is reflected in the magnitude of immunosuppression required. As with other solid organ transplants acute cellular rej...

Infectious complications Infection is the leading cause of death in multivisceral/ intestinal transplant recipients. This is as a consequence of the degree of immunosuppression and also the potential for bacterial translocation across the graft mucosa. Oppor...

INTRODUCTION The first reported intestine-containing transplant in humans was performed in 1966, when a short segment of duodenum was included in a pancreas transplant. This was followed by attempts to transplant more substantial amounts of intestine, but the...

Learning objectives To understand: The indications for intestinal transplantation • The assessment process for intestinal transplantation • The different transplant types •

OUTCOMES Graft and patient outcomes vary depending on the type of transplant undertaken with survival post-multivisceral trans plant being markedly poorer than isolated small intestinal transplant. As with many transplant groups, outcomes are improving over ti...

POST-TRANSPLANT COMPLICATIONS With the complexity of multivisceral/intestinal transplantation complications are common ( Table 91.3 ).

PREOPERATIVE PLANNING The decision regarding the type of transplant to be performed is dependent on a variety of patient factors. Intraoperative flexibility is necessary and may change the type of transplant undertaken. A robust plan for adequate venous acce...

SUMMARY Multivisceral and intestinal transplantation remains a complex and uncommon treatment, however it can be life-saving. The risks are high but with improvements in surgical techniques, - especially the introduction of preoperative embolisation, the int...