Spleen Preserving Modified Multi Visceral Transplant

LUIS MOULIN; NÉSTOR PEDRAZA; JUAN PADIN; SILVIA NYVEIRO; GRACIELA TUHAY; ANA CABANNE; FABIO NACHMAN; PABLO BARROS SCHELOTTO; HECTOR SOLAR; DIEGO RAMISCH; GABRIEL E. GONDOLESI

Simposio; International Small Bowel Transplant Symposium 2015; 2015

Intestinal Transplant Association

Case Presentation: 24 year old male, diagnosed with PeutzJeghersSyndrome at a paediatric age. Multiple interventions wereneeded for recurrent intussusceptions caused by large polyps, requiringintestinal resections. Referred for small bowel evaluation withouthaving IF. Pre-transplant work-out showed more than 150 polypsalong the GI tract, with more than 6 cm in diameter for the largestones, biopsies performed on those showed high grade dysplasia.Decision was to list him for an spleen- preserving modified multivisceraltransplantation.Procedure: an 18 year old ideal, trauma donor was offered. The multivisceralblock including stomach, duodenum-pancreatic complex,small bowel and right extended colon was procured. The recipientsurgery started with a midline incision, GI tract resection was startedby mobilizing the right colon, together with the root of the mesenteryup to identify the SMA. Then, the left colon was mobilized and transacted.The liver hiliar dissection was started by identifying the bileduct follow by its transaction, and dissection of the hepatic artery uto the celiac trunk and the portal vein down to the spleno-mesentericjunction. The esophagus-gastric junction was encircled and gastrictransaction done. After that, the pancreas was dissected from the tailto head following and preserving the splenic vein and artery to preservethe spleen. Evisceration was completed with transaction ofSMA and SMV. For engraftment, an arterial conduit was placed directlyto the aorta; and it was sutured to the aortic patch of the multivisceralgraft. Portal reconstruction was accomplished in anend-to-side fashion in the anterior wall of the main portal vein. TIT:7:20 hs; CIT: 45 minutes. Duct-to-duct anastomosis was done overa 5 Fr T-tube. GI tract reconstruction was done with a proximal gastro-gastricanastomosis and piloroplasty; the distal colo-rectal anastomosiswas done using a circular stapler. The procedure finishedby placing a gastrojejunostomy tube and loop ileostomy for distalgraft monitoring.Outcome: patient stayed 2 days at ICU, enteral feedings werestarted on postoperative day 7. No infections or rejections occurred.PN was used only for 10 days postoperative. He is currently alive,and rejection free 23 months post-transplant.References:1. Transplantation. 2007;84:1208-12092. Ann Surg. 2005;242:480-490.3. Gastroenterology 2003; 124: 1615-16284. Transplantation. 2007;83(2):234-6.