Thomas E Starzl Transplantation Institute, University of Pittsburgh Medical Center, 3459 Fifth Avenue, MUH 7 South, Pittsburgh, PA 15213, USA.
J Gastrointest Surg. 2010 Nov;14(11):1709-21. doi: 10.1007/s11605-010-1317-5. Epub 2010 Sep 17.
Modification of the originally described multivisceral transplant operation was introduced at our institution 17 years ago. Donor liver was spared, and native spleen along with pancreaticoduodenal complex was preserved.
Thirty-six modified multivisceral grafts that include stomach, duodenum, pancreas, and intestine were given to 30 adults and six children. Leading causes of intestinal failure were pseudo-obstruction and Gardner's syndrome. Native spleen was preserved in 24 (67%) recipients along with pancreaticoduodenal complex in 18 (50%). Immunosuppression was tacrolimus-based, and recipient preconditioning was utilized in 80% of patients.
Patient survival was 94% at 1 year and 75% at 5 years with graft survival of 91% and 51%; respectively. With mean follow-up of 51 ± 35 months, full nutritional autonomy was achieved in 89% of current survivors with no single example of disease recurrence. Preservation of native spleen was associated with increased survival and reduced risk of PTLD, life-threatening infections, and GVHD with no significant impact on graft loss due to rejection. Concomitant preservation of pancreaticoduodenal complex eliminated risks of biliary complications and glucose intolerance.
Modified multivisceral transplantation with and without preservation of native spleen, pancreas, and duodenum is a valid therapeutic option for patients with diffuse gastrointestinal disorders and preserved hepatic functions.
17 年前，我们机构引入了最初描述的多脏器移植手术的改良。保留了供肝，同时保留了固有脾脏和胰十二指肠复合体。
36 例改良多脏器移植物包括胃、十二指肠、胰腺和肠，用于 30 名成人和 6 名儿童。肠衰竭的主要原因是假性肠梗阻和 Gardner 综合征。24 名（67%）受者保留了固有脾脏，18 名（50%）受者保留了胰十二指肠复合体。免疫抑制采用他克莫司为基础，80%的患者采用受体预处理。
患者 1 年生存率为 94%，5 年生存率为 75%，移植物 1 年生存率为 91%，5 年生存率为 51%；中位随访时间为 51±35 个月，目前幸存者中 89%实现了完全营养自主，无疾病复发的单一病例。保留固有脾脏与生存率的提高和 PTLD、危及生命的感染和 GVHD 的风险降低相关，而与排斥导致的移植物丢失无关。同时保留胰十二指肠复合体可消除胆道并发症和葡萄糖不耐受的风险。
保留或不保留固有脾脏、胰腺和十二指肠的改良多脏器移植术是治疗弥漫性胃肠道疾病和保留肝功能患者的有效治疗选择。
