Department of Surgery, University of Miami, Jackson Memorial Hospital, Miami Transplant Institute, Florida, USA.
University of Sao Paulo Medical School, University of Sao Paulo, Sao Paulo, Brazil.
Curr Opin Organ Transplant. 2024 Feb 1;29(1):88-96. doi: 10.1097/MOT.0000000000001098. Epub 2023 Oct 30.
This timely review delves into the evolution of multivisceral transplantation (MVT) over the past six decades underscoring how advancements in surgical techniques and immunosuppression have driven transformation, to provide insight into the historical development of MVT, shedding light on its journey from experimentation to a valuable clinical approach.
The review presents contemporary enhancements in surgical methods within the context of intestinal transplantation. The versatility of MVT is emphasized, accommodating diverse organ combinations and techniques. Both isolated intestinal transplantation (IIT) and MVT have seen expanded indications, driven by improved parenteral nutrition, transplantation outcomes, and surgical innovations. Surgical techniques are tailored based on graft type, with various approaches for isolated transplantation. Preservation strategies and ostomy techniques are also covered, along with graft assessment advancements involving donor-specific antibodies.
This review's findings underscore the remarkable evolution of MVT from experimental origins to a comprehensive clinical practice. The progress in surgical techniques and immunosuppression has broadened the spectrum of patients who can benefit from intestinal transplant, including both IIT and MVT. The expansion of indications offers hope to patients with complex gastrointestinal disorders. The detection of donor-specific antibodies in graft assessment advances diagnostic accuracy, ultimately improving patient outcomes.
本文深入探讨了多器官联合移植(MVT)在过去六十年中的发展演变,强调了手术技术和免疫抑制方面的进步如何推动了这一领域的变革,为理解 MVT 的历史发展提供了深入洞察,展示了它从实验阶段到具有重要临床价值的转变历程。
本综述介绍了目前在肠道移植背景下的手术方法的改进。强调了 MVT 的多功能性,能够适应多种器官组合和技术。由于肠外营养、移植结果和外科创新的改善,孤立肠移植(IIT)和 MVT 的适应证均有所扩大。根据移植物类型定制手术技术,包括孤立移植的各种方法。还涵盖了保存策略和造口技术,以及涉及供体特异性抗体的移植物评估进展。
本综述的研究结果强调了 MVT 从实验起源到全面临床实践的显著发展。手术技术和免疫抑制方面的进展拓宽了受益于肠移植的患者范围,包括 IIT 和 MVT。适应证的扩大为患有复杂胃肠道疾病的患者带来了希望。在移植物评估中检测到供体特异性抗体可提高诊断准确性,最终改善患者的预后。