MCACS - Multivisceral Transplantation for Abdominal Malignancy: A Single Center Experience

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Multivisceral Transplantation for Abdominal Malignancy: A Single Center Experience
Eliza Lee, MD; Kristina Potanos, MD; Nora Fullington, MD; Ryan Cauley, MD; Nicole Hodgkinson; Gulcin Demirci, MD, PhD; Khashayar Vakili, MD; Heung Bae Kim, MD
Surgery, Pediatric Transplant Center, Boston Children’s Hospital, Boston, MA Introduction: Standard management of intra-abdominal pediatric solid tumors requires complete resection. However, tumors with multiple organ and vascular involvement present a unique surgical challenge. We present four cases of multivisceral transplantation (MVT) for intra-abdominal malignancies with significant involvement of the visceral arteries and/or portomesenteric venous system.

Methods: We conducted a retrospective chart review of patients undergoing MVT for intra-abdominal malignancies at our institution.

Results: We identified four patients who underwent MVT for unresectable intra-abdominal malignancies at our center. Patient characteristics are listed in Table 1. Indications for MVT included hepatocellular carcinoma (HCC), inflammatory myofibroblastic tumor, and two cases of hepatoblastoma (HB). Grafts included liver, stomach, small bowel, and pancreas in all patients, with two patients also receiving spleens, and one, a partial esophageal transplant. Median hospital stay was 80 days (range 64-159 days). Postoperative complications included reoperation for abdominal hematoma and bowel obstruction, steroid responsive intestinal rejection, wound dehiscence, fungemia, seizures, chyle leak with pleural effusion, and post-transplant lymphoproliferative disease (PTLD). On follow-up (range 1-6 years), all patients have satisfactory graft function and no evidence of recurrent disease.

Conclusion: Multivisceral transplantation is an effective means of providing complete resection of intra-abdominal malignancies found to have multiple organ and vascular involvement.

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