Transplantation of the abdominal wall

• Published in: The Lancet (British edition) 2003-06, Vol.361 (9376), p.2173-2176
• Main Authors: Levi, David M, Tzakis, Andreas G, Kato, Tomoaki, Madariaga, Juan, Mittal, Naveen K, Nery, Jose, Nishida, Seigo, Ruiz, Phillip
• Format: Article
• Language: English
• Subjects: Abdomen; Abdominal Wall - blood supply; Abdominal Wall - surgery; Adipose Tissue - transplantation; Adolescent; Adult; Alemtuzumab; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized; Antibodies, Neoplasm - therapeutic use; Biological and medical sciences; Child; Child, Preschool; Corticoids; Digestive System Surgical Procedures - methods; Fascia - transplantation; Graft Rejection - prevention & control; Humans; Immunosuppressive Agents - therapeutic use; Infant; Intestines - transplantation; Liver Transplantation - methods; Lymphocytes; Male; Medical sciences; Middle Aged; Pancreas Transplantation - methods; Rectus Abdominis - transplantation; Skin; Skin Transplantation; Stomach; Stomach - transplantation; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Surgical Flaps - blood supply; Tacrolimus - therapeutic use; Transplantation; Transplantation, Homologous; Transplants & implants; Treatment Outcome
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(03)13769-5

Closure of the abdomen in patients undergoing intestinal transplantation can be extremely difficult, if not impossible. We describe our initial experience with abdominal wall allotransplantation to facilitate abdominal closure. We undertook nine cadaveric abdominal wall composite allograft transplants in eight patients. The graft's blood supply was based on the inferior epigastric vessels left in continuity with the donor femoral and iliac vessels. Skin biopsies were undertaken randomly and when rejection was suspected. Vessel patency was monitored by doppler ultrasound. Six patients have survived, five of whom have intact, viable abdominal wall grafts. Two patients have had a clinically mild episode of acute rejection of the skin of the abdominal wall that resolved with corticosteroid therapy. No clinically apparent graft-versus-host disease has been noted. Transplantation of an abdominal wall composite allograft can facilitate reconstruction and closure of the abdominal compartment in intestinal transplant recipients with complex abdominal wall defects.