Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland).
Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, Guangdong, China (mainland).
Ann Transplant. 2022 Mar 15;27:e935860. doi: 10.12659/AOT.935860.
BACKGROUND Abdominal organ cluster transplantation for the treatment of upper abdominal end-stage diseases is a serious conundrum for surgeons. CASE REPORT We performed clinical assessment of quadruple organ transplantation (liver, pancreas, duodenum, and kidney) for a patient with end-stage liver disease, post-chronic hepatitis B cirrhosis, uremia, and insulin-dependent diabetes mellitus, and explored the optimal surgical procedure. Simultaneous classic orthotopic liver, pancreas-duodenum, and heterotopic renal transplantation was performed on a 46-year-old man. The process was an improvement of surgery implemented with a single vascular anastomosis (Y graft of the superior mesenteric artery and the celiac artery open together in the common iliac artery). The pancreatic secretions and bile were drained through a modified uncut jejunal loop anastomosis, and the donor's kidneys were placed in the right iliac fossa. The patient was prescribed basiliximab, glucocorticoid, tacrolimus, and mycophenolate mofetil for immunosuppression. The hepatic function recovered satisfactorily on postoperative day (POD) 3, and pancreatic function recovered satisfactorily in postoperative month (POM) 1. Hydronephrosis occurred in the transplanted kidney, with elevated creatinine on POD 15. Consequently, renal pelvic puncture and drainage were performed. His creatinine dropped to a normal level on POD 42. No allograft rejections or other complications, like pancreatic leakage, thrombosis, or localized infections, occurred. The patient had normal liver, renal, and pancreas functions with insulin-independent after POD 365. CONCLUSIONS Simultaneous classic orthotopic liver, pancreas-duodenum, and heterotopic renal transplantation is a promising therapeutic option for patients with insulin-dependent diabetes combined with end-stage hepatic and renal disease, and our center's experience can provide a reference for clinical multiorgan transplantation.
腹部器官簇移植治疗上腹部终末期疾病是外科医生面临的严峻难题。
我们对 1 例终末期肝病、慢性乙型肝炎后肝硬化、尿毒症和胰岛素依赖型糖尿病患者进行了四重器官移植（肝、胰、十二指肠和肾）的临床评估，并探讨了最佳手术方案。一名 46 岁男性患者接受了经典原位肝、胰腺十二指肠和异位肾同时移植。该过程是在单一血管吻合术（肠系膜上动脉和腹腔动脉的 Y 形吻合在共用髂动脉中开放）的基础上进行的改进。胰液和胆汁通过改良的非切割空肠襻吻合引流，供者的肾脏被置于右髂窝。患者接受巴利昔单抗、糖皮质激素、他克莫司和霉酚酸酯进行免疫抑制治疗。术后第 3 天肝功能恢复满意，术后第 1 个月胰腺功能恢复满意。移植肾发生肾盂积水，术后第 15 天肌酐升高。因此，进行了肾盂穿刺引流。术后第 42 天，肌酐降至正常水平。无移植物排斥反应或其他并发症，如胰漏、血栓形成或局部感染。术后 365 天，患者肝功能、肾功能和胰腺功能正常，无需胰岛素。
对于同时合并终末期肝、肾疾病和胰岛素依赖型糖尿病的患者，经典原位肝、胰腺十二指肠和异位肾同时移植是一种有前途的治疗选择，我们中心的经验可为临床多器官移植提供参考。
