2013 - ISBTS 2013 Symposium
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Posters and Exhibition
15.2 - Cluster transplantation: new indications for and old technique in a liver and intestinal transplant program.
Presenter: Ane, Andres, , Spain
Authors: Ane Andres1, Francisco Hernandez1, Jose Luis Encinas1, Manuel Gamez1, Esteban Frauca2, Loreto Hierro2, Paloma Jara2, Manuel Lopez Santamaria1
Cluster transplantation: new indications for and old technique in a liver and intestinal transplant program.
Ane Andres1, Francisco Hernandez1, Jose Luis Encinas1, Manuel Gamez1, Esteban Frauca2, Loreto Hierro2, Paloma Jara2, Manuel Lopez Santamaria1
1Pediatric Surgery, Hospital La Paz, Madrid, Spain; 2Pediatric Hepatology, Hospital La Paz, Madrid, Spain
Background/Aim: Despite the concept of “cluster transplantation” was originally described by Starzl and its intestinal modalities have been widely accepted, the en-bloc liver and pancreas technique (BLPTx) , however, died out after being used in malignant tumors due to poor results.
Cystic fibrosis is a multisystemic disease in some cases developing liver failure requiring liver transplantation. Exocrine pancreas insufficiency appears in almost 100% of the cases with severe mutations, leading to long-term insulin-dependent endocrine insufficiency.
Furthermore immunosuppressants may induce insulin dependent diabetes and kidney failure in liver transplant recipients.
Our aim was to show the feasibility and our preliminary results with the BLPTx.
Patient/ Methods: Since 2009, this technique was offered to all patients with liver failure and insulin-dependent diabetes. The graft included the liver and the pancreas with a C-loop of duodenum and a donor aortic patch. End-to-end portal vein anastomosis was performed between the pancreatic graft and the native pancreas. A roux-en-y was anastomosed to the distal C-loop. Arterial anastomosis was similar to a multivisceral transplant. Technical difficulties, early complications and long-term results were analyzed.
Results: 5 patients were listed, and 3 have been transplanted so far: 2 were teenegers with cystic fibrosis (15 and 16 yo); after 2.3 years and 2 months of follow-up, their liver function is normal and both are insulin-free since the first month after transplant. Complications included one mild rejection episode which responded to steroids, and one early acute pancreatitis with perforation of the duodenal lump, requiring surgery 2 weeks after transplant. The third patient died in the early postoperative period; she was a chronically ill 5 yo girl, with a metabolic liver disease who had previously received 3 liver transplants developing diabetes and renal failure, before the BLPTx including one kidney. There are 2 more teenagers listed for this type of transplant, with cystic fibrosis and polycistic hepatorenal disease with a prior kidney transplant, respectively.
Conclusions BLPTx with/out kidneys has been rescued from the past for new indications such as cystic fibrosis or prior transplanted patients with concomitant immunosuppressants adverse events . Preliminary results show this feasible technique as an attractive multidisciplinary option for the patient. New indications will be proposed as soon as long term results will became evident.
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