Abdominal multivisceral transplantation.
Under FK506-based immunosuppression, 13 abdominal multivisceral transplantations were performed in 6 children and 7 adults. Of the 13 recipients, 7 (53.8%) are alive and well with functioning grafts after 9 to 31 months. Six recipients died: three from PTLD, one from rejection, one from sepsis, and one from respiratory failure. In addition to rejection, postoperative complications occurring in more than isolated cases included PTLD (n = 6), abdominal abscess formation (n = 5), pancreatitis (n = 3), and ampullary dysfunction (n = 2). In addition, infection by enteric microorganisms was common during the early postoperative period. Currently, all 7 survivors are on an oral diet and have normal liver function. Two recipients (one insulin-dependent) require antidiabetes treatment, in one case following distal pancreatectomy and in the other after two episodes of pancreatic rejection. Thus, abdominal multivisceral transplantation is a difficult but feasible operation that demands complex and prolonged posttransplantation management. It is not yet ready for application and awaits a better strategy of immune modulation.
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Pittsburgh Transplantation Institute, University of Pittsburgh Medical Center, Pennsylvania 15213.
Tzakis
A
A
Abu-Elmagd
K
K
Reyes
J
J
Furukawa
H
H
Nour
B
B
Fung
J
J
Demetris
A
A
Starzl
T E
TE
D000005:Abdomen; D000328:Adult; D002648:Child; D002675:Child, Preschool; D013505:Digestive System Surgical Procedures; D006084:Graft Rejection / Q000150:complications / Q000517:prevention & control; D006801:Humans; D007223:Infant; D007422:Intestines / Q000637:transplantation*; D008232:Lymphoproliferative Disorders / Q000209:etiology; D008875:Middle Aged; D016019:Survival Analysis; D016559:Tacrolimus / Q000627:therapeutic use; D014781:Viscera / Q000637:transplantation*
D016559:Tacrolimus