En-Bloc Transplant of the Liver, Kidney and Pancreas: Experience from a Latin American Transplant Center.
BACKGROUND En-bloc transplantation is a surgical procedure in which multiple organs are transplanted simultaneously. It has some similarities with multi-organ transplantation but offers certain advantages. This report highlights the experience of our interdisciplinary group regarding the treatment and follow-up of patients who received en-bloc transplantation, with the aim of encouraging the development of this surgical technique. CASE REPORT The first case is a 38-year-old patient with type 1 diabetes mellitus, liver cirrhosis, and chronic kidney failure who received an en-bloc transplant of the liver, pancreas, and kidney with no intraoperative complications. He had a prolonged hospital stay due to anemia and systemic inflammatory response syndrome, which were resolved successfully. At follow-up, he had no requirement for insulin or for dialysis, or for new interventions. The second case describes a 48-year-old patient with type 2 diabetes mellitus, renal failure, and liver cirrhosis who received an en-bloc transplant of the liver, pancreas, and kidney with no complications. During the postoperative period, the patient suffered a possible episode of acute tubular necrosis, which evolved towards improvement, with a tendency to normal metabolic and renal functioning, with no additional events. The patient is currently in follow-up and is insulin-independent. CONCLUSIONS En-bloc transplantation is a safe procedure, which is technically simple and which achieves excellent results. This procedure is indicated in patients with end-stage renal disease, cirrhosis, and diabetes mellitus that is difficult to control.
Abdominal Transplantation Surgery, Transplantation Unit, Centre for Clinical Research, Fundación Valle de Lili, Centre for Research on Advanced Surgery and Transplants (CICAT), Universidad Icesi, Cali, Valle del Cauca, Colombia.
Luis A
LA
Caicedo
Abdominal Transplantation Surgery, Transplantation Unit, Centre for Clinical Research, Fundación Valle de Lili, Centre for Research on Advanced Surgery and Transplants (CICAT), Universidad Icesi, Cali, Valle del Cauca, Colombia.
Jorge I
JI
Villegas
Abdominal Transplantation Surgery, Transplantation Unit, Centre for Clinical Research, Fundación Valle de Lili, Centre for Research on Advanced Surgery and Transplants (CICAT), Universidad Icesi, Cali, Valle del Cauca, Colombia.
Oscar
O
Serrano
Abdominal Transplantation Surgery, Transplantation Unit, Centre for Clinical Research, Fundación Valle de Lili, Centre for Research on Advanced Surgery and Transplants (CICAT), Universidad Icesi, Cali, Valle del Cauca, Colombia.
Mauricio
M
Millán
Department of Internal Medicine, Gastroenterology and Hepatology, Gastroenterology Unit, Centre for Clinical Research Fundación Valle de Lili, Centre for Research on Advanced Surgery and Transplants (CICAT), Universidad Icesi, Cali, Valle del Cauca, Colombia.
Mauricio
M
Sepúlveda
Department of Internal Medicine, Gastroenterology and Hepatology, Gastroenterology Unit, Centre for Clinical Research Fundación Valle de Lili, Centre for Research on Advanced Surgery and Transplants (CICAT), Universidad Icesi, Cali, Valle del Cauca, Colombia.
Diego
D
Jiménez
Department of Internal Medicine, Gastroenterology and Hepatology, Gastroenterology Unit, Centre for Clinical Research Fundación Valle de Lili, Centre for Research on Advanced Surgery and Transplants (CICAT), Universidad Icesi, Cali, Valle del Cauca, Colombia.
Jairo
J
García
Department of Internal Medicine and Nephrology, Internal Medicine Unit, Centre for Clinical Research Fundación Valle de Lili, Centre for Research on Advanced Surgery and Transplants (CICAT), Universidad Icesi, Cali, Valle del Cauca, Colombia.
Juan G
JG
Posada
Department of Internal Medicine and Nephrology, Internal Medicine Unit, Centre for Clinical Research Fundación Valle de Lili, Centre for Research on Advanced Surgery and Transplants (CICAT), Universidad Icesi, Cali, Valle del Cauca, Colombia.
Liliana
L
Mesa
Department of Internal Medicine and Nephrology, Internal Medicine Unit, Centre for Clinical Research Fundación Valle de Lili, Centre for Research on Advanced Surgery and Transplants (CICAT), Universidad Icesi, Cali, Valle del Cauca, Colombia.
Carlos
C
Duran
Department of Internal Medicine and Nephrology, Internal Medicine Unit, Centre for Clinical Research Fundación Valle de Lili, Centre for Research on Advanced Surgery and Transplants (CICAT), Universidad Icesi, Cali, Valle del Cauca, Colombia.
Johanna
J
Schweineberg
Department of Public health, Centre for Research on Advanced Surgery and Transplants (CICAT), Universidad Icesi, Cali, Valle del Cauca, Colombia.
Diana
D
Dávalos
Centre for Clinical Research, Transplant Unit, Fundación Valle de Lili, Cali, Valle del Cauca, Colombia.
Eliana
E
Manzi
Centre for Clinical Research, Transplant Unit, Fundación Valle de Lili, Cali, Valle del Cauca, Colombia.
Angie
A
Sabogal
Centre for Clinical Research, Transplant Unit, Fundación Valle de Lili, Cali, Valle del Cauca, Colombia.
Ana María
AM
Aristizabal
Abdominal Transplantation Surgery, Transplantation Unit, Centre for Clinical Research, Fundación Valle de Lili, Centre for Research on Advanced Surgery and Transplants (CICAT), Universidad Icesi, Cali, Valle del Cauca, Colombia.
Gabriel J
GJ
Echeverri
D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery*; D003924:Diabetes Mellitus, Type 2 / Q000601:surgery*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods; D008103:Liver Cirrhosis / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000379:methods; D016896:Treatment Outcome