Abdominal Wall Transplantation: Indications and Outcomes

Abstract

Purpose of Review This article aims to review published outcomes associated with full-thickness vascularized abdominal wall transplantation, with particular emphasis on advances in the field in the last 3 years. Recent Findings Forty-six full-thickness vascularized abdominal wall transplants have been performed in 44 patients worldwide. Approximately 35% of abdominal wall transplant recipients will experience at least one episode of acute rejection in the first year after transplant, compared with rejection rates of 87.8% and 72.7% for hand and face transplant respectively. Recent evidence suggests that combining a skin containing abdominal wall transplant with an intestinal transplant does not appear to increase sensitization or de novo donor-specific antibody formation. Summary Published data suggests that abdominal wall transplantation is an effective safe solution to achieve primary closure of the abdomen after intestinal or multivisceral transplant. However, better data is needed to confirm observations made and to determine long-term outcomes, requiring standardized data collection and reporting and collaboration between the small number of active transplant centres around the world.

Heterotopic intestine and abdominal wall transplantation in a miniature swine: A model for graft immunology

“…However, in the 14 cases reported by Miami and Bologna, ACRs of AW‐VCA and ITx did not occur together and were always discordant 3 ; accordingly, the utility of AW‐VCA skin as an immune monitor for ITx needs to be assessed and verified 4 . However, it may be unethical to observe skin rejection and withhold immunosuppressants to see whether the intestine will subsequently undergo cellular rejection, 3 so comparing AW‐VCA skin and ITx mucosa rejections should rely on animal models.…”

“…Abdominal wall‐vascularized composite allotransplantation (AW‐VCA) was successfully proposed in 2001 to provide abdominal coverage for patients after ITx 2 . Over the past two decades, 46 AW‐VCAs have been performed in 44 patients across seven international medical centers worldwide 3 . Moreover, AW‐VCA skin can facilitate early detection of acute cellular rejection (ACR) of ITx since Gerlach et al from Oxford reported no cases of ITx mucosa ACR without preceding or simultaneous AW‐VCA skin ACR 2,3 …”

Closing the abdomen: update on the current surgical toolkit

“…The potential advantage would be the preservation of the donor iliac vessels for the vascular toolkit. Overall, a recent collection of the worldwide experience has reported 46 AWT transplants performed in 44 patients [20 ▪▪ ,21–23] (see Table 1). The reported 1- and 3-year intestinal graft survival rates were 94% and 57%, respectively in this cohort.…”

“…AWT, abdominal wall transplant; GvHD, graft versus host disease; PTLD, posttransplant lymphoproliferative disease.Adapted from Honeyman et al [20 ▪▪ ].…”

“…The potential for early loss of the AWT, for instance, due to thrombosis, is a rare (4.3% – 2/46 patients). However, this is a potentially devastating complication as it can lead to a prolonged open abdomen with an exposed intestinal graft [20 ▪▪ ]. Late AWT losses, such as after chronic rejection, have been also been described [24].…”