Elsevier

Transplantation Proceedings

Volume 37, Issue 6, July–August 2005, Pages 2425-2427
Transplantation Proceedings

Organ donation and allocation
Multivisceral Harvest With In Vivo Technique: Methods and Results

https://doi.org/10.1016/j.transproceed.2005.06.090Get rights and content

Abstract

Multivisceral transplants are gaining acceptance worldwide for patients with chronic gastrointestinal failure with or without irreversible total parenteral nutrition (TPN)-related liver failure. We describe our experience with nine multivisceral harvests reporting our in vivo technique. Multivisceral grafts included stomach, duodenum, pancreas, small bowel, and part of large intestine with or without the liver. After a careful evaluation of the liver and the bowel, we isolated the superior mesenteric artery origin. Then we identified the distal part of the graft isolating the middle colic vein and stapling the transverse colon to its left. After esophagus isolation and stapling, we mobilized the graft, starting from the spleen to the pancreaticoduodenal block, near the celiac trunk. After cross-clamping and cold perfusion, we created an aortic patch including the superior mesenteric artery and celiac trunk as a multivisceral harvest without the liver. A total hepatectomy is added for a liver multivisceral graft.

We harvested four multivisceral grafts without the liver and five multivisceral grafts with the liver. We performed seven multivisceral transplants on adult recipients, four without the liver and three with the liver, as well as two liver and one isolated small bowel transplants. Postreperfusion hemostasis was always satisfactory with a mean ischemia time of 6.5 hours. Four recipients died: there was one intraoperative death due to disseminated intravascular coagulopathy. Another patient underwent graftectomy 1 day after transplantation due to vascular thrombosis.

In conclusion, our in vivo technique allows a shorter ischemia time with a minimal postreperfusion bleeding and reduced production of lymphatic ascites, without jeopardizing organ function.

Section snippets

Patients and methods

Careful selection of the donor was performed with the utmost attention paid particularly to body weight and residual abdominal cavity of the recipient. If judged suitable, the donor underwent selective bowel decontamination following our protocol, as described elsewhere.1, 2 Most donors were under 30 years of age, died for cerebrovascular accident, were hemodynamically stable, had minimal or no vasoactive amine support. After laparotomy, we carefully evaluated the liver and the bowel. If there

Results

From February 2001 to November 2004, we performed nine multivisceral harvests. We evaluated a larger number of donors for this purpose but, for the reasons described we aborted the procedure when any doubt was present concerning the donor. If accessory right or left branches to the liver (from SMA or left gastric artery) were present in cases of multivisceral harvests without the liver, we left the donor for the liver team. We harvested four multivisceral grafts without the liver and five

Discussion

The in vivo technique allows a shorter ischemia time compared to an en block retrieval followed by prolonged, tedious back table dissection. There is minimal postreperfusion bleeding and reduced production of lymphatic ascites, the other landmarks of this technique. Our preliminary results on a small sample of patients seem to show that the in vivo technique is feasible without jeopardizing organ function.

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