Abdominal cluster transplantation and management of perioperative hemodynamic changes.
BACKGROUND
Multivisceral transplantation (MTX, or cluster transplantation) is defined as the transplantation of three or more abdominal organs en bloc, namely the liver together with the pancreatoduodenal complex, the stomach as well as the small bowel with/without the right hemicolon. Up to May 1999, only 72 cases were reported to the Intestinal Transplant Registry. Organ cluster transplantation may carry with complex hemodynamic alterations. Based on our experience in two cases of abdominal cluster transplantation, we describe the technical details of multivisceral transplantation and the management of hemodynamic changes.


METHODS
A Swan-Ganz catheter was placed to assist in monitoring the patients' hemodynamic status. After the transplantation, the 2 patients were closely observed in the intensive care unit in terms of vital signs;disseminated intravascular coagulation (DIC) including activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), fibrinogen (Fg) and D-dimer, and arterial blood gas; and quantity and characteristics of drainage. Additionally, intra-abdominal hemorrhage was supervised by bedside B-ultrasonography or enhanced computed tomography (CT) examination. Whole blood viscosity was monitored 2 weeks after transplantation. The blood flow of the hepatic artery and portal vein and arterial resistant index were assessed routinely by Doppler ultrasonography.


RESULTS
Hemodynamic changes were observed during perioperation. Liver and renal function recovered within one week after transplantation. Enteral feedings and oral intake were gradually increased with a reciprocal decrease in parenteral nutrition. Despite systemic antibiotics were given according to the results of frequent cultures, patient 1 died from cytomegalovirus (CMV) infection 4 months after transplantation and patient 2 died of a systemic sepsis 2 months after the operation.


CONCLUSIONS
Many factors contribute to the success of multivisceral transplantation. In order to maintain hemodynamics stable during perioperation, preoperative coagulatory function should be corrected, and stable circulation, serum electrocyte balance, and normal body temperature should be kept during the operation in addition to the treatment of intra-abdominal hemorrhage and making up for the loss of body fluid. However, complications, infection and rejection are barriers for the improvement of graft survival.
Chen
Hui-Xing
HX
Department of Surgery and Center of Organ Transplantation, Ruijin Hospital, Shanghai Second Medical University, Shanghai 200025, China.
Yin
Lu
L
Peng
Cheng-Hong
CH
Zhou
Guang-Wen
GW
Shen
Bai-Yong
BY
Chen
Hao
H
Shen
Chuan
C
Li
Hong-Wei
HW
D018256:Adenomatous Polyps / Q000601:surgery; D000328:Adult; D001794:Blood Pressure / Q000502:physiology*; D002302:Cardiac Output / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D005770:Gastrointestinal Neoplasms / Q000601:surgery; D019694:Hepatitis B, Chronic / Q000150:complications / Q000601:surgery; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications / Q000601:surgery; D007422:Intestines / Q000637:transplantation*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008991:Monitoring, Physiologic; D016035:Pancreas Transplantation / Q000379:methods*; D019990:Perioperative Care / Q000379:methods; D013154:Spleen / Q000637:transplantation*; D013270:Stomach / Q000637:transplantation*