Introduction: The abdominal wall (AW), may be severely compromised in the vast majority of intestinal and multiorgan transplant candidates, and sometimes as consequence of a complex liver transplant. Multiple options have been described to overcome this problem. Our aim is to report the largest and longest-term follow-up of patients that received an AW, non-Vascularized, non-Composite allograft (AW-non-V non-CA), as it has been proposed to call the Abdominal Rectus Fascia; after liver, intestinal or multiorgan transplantation at a single center.

Methods: This is a retrospective report of a prospectively collected data set of all the patients (pts.) that received AW-non-V non-CA after a liver, isolated intestine, combined, or multiorgan transplantation at our institution, from May 2006 to June 2016.

Results: A total of 19 pts. received an AW-non-V non-CA  from 2006 to 2016; 17 after an intestinal containing graft: and 2 after liver re-transplantation. Nine pts. were children. Mean follow-up 52.17 ± 43.6 months. No pts. develop ventral hernias. Three patients required replacement of the AW-non-V non-CA; 2 by a synthetic mesh and 1 with other ARF. Twelve recipients of the AW-non-V non-CA (63.15%) required 23 re-operations (re-op). Six pts required early re-op, 5 pts required late re-op and 1 pt. both. Late re-op were performed by transecting the ARF, throughout the midline. In all late re-op, the ARF was found to be integrated to the AW; and none or mild soft adhesions to the inner surface of the AW-non-V non-CA were found. None of the 2 patients who received liver re-transplantation and ARF developed ventral defects, or required re-op. Conclusion: The use of ARF, a AW-non-V non-CA, has become a simple and reliable surgical option to close abdominal wall defects after abdominal organ transplantation; it is capable of resisting multiple re-op, wound infections and, when necessary, it could be replaced. In the long term it does integrates to the abdominal wall and does not cause adhesions when the inner peritoneal layer is preserved.

[1] Selvaggi G. Expanded use of transplantation techniques: Abdominal wall transplantation and intestinal autotransplantation. Transplant Proc. 2004;36(5):1561–3
[2] Selvaggi G. Abdominal Wall Transplantation: Surgical and Immunologic Aspects. Transplant Proc. 2009;41(2):521–2.
[3] Alexandrides Ioannis J. Abdominal Wall Closure after Intestinal Transplantation. Plasti. 2000;106(4):805–12
[4] Levi DM. Transplantation of the abdominal wall. Lancet. 2003;361(9376):2173–6.
[5] Gondolesi G. Use of the abdominal rectus fascia as a nonvascularized allograft for abdominal wall closure after liver, intestinal, and multivisceral transplantation. Transplantation. 2009;87(12):1884–8
[6] Gerlach UA. Technical advances for abdominal wall closure after intestinal and multivisceral transplantation. Curr Opin Organ Transplant. 2012;17(3):258–67
[7] Mangus RS. Closure of the abdominal wall with acellular dermal allograft in intestinal transplantation. Am J Transplant. 2012;12(SUPPL 4).
[8] Cipriani R. Abdominal wall transplantation with microsurgical technique. Am J Transplant. 2007;7(5):1304–7.
[9] Jafri Mubeen A. Temporary Silastic Mesh Closure for Adult Liver Transplantation: A Safe Alternative for the Difficult Abdomen. Liver Transplant. 2007;13(3):258–65
[10] Watson MJ. Role of tissue expanders in patients with loss of abdominal domain awaiting intestinal transplantation. Transpl Int. 2013;26(12):1184–90.
[11] Gerlach UA. Abdominal Wall Transplantation: Skin as a Sentinel Marker for Rejection. Am J Transplant. 2016;(7):1892–900.
[12] Berli JU. Current concepts and systematic review of vascularized composite allotransplantation of the abdominal wall. Clin Transplant. 2013; 27:781-789.