Abdominal Wall Transplantation: Surgical and Immunologic Aspects

Risk assessment and management in hand and facial tissue transplantation

“…The recent clinical introduction of composite tissue allotransplantation (CTA) in the form of bone and joint [4], muscle [5], cornea [6], larynx [7], tongue [8], abdominal wall [9], uterus [10], hand [11], and facial tissue [12] transplants has provided new therapeutic modalities for patients suffering with large tissue defects and is revolutionizing the fields of transplant and reconstructive surgery.…”

Functional Abdominal Wall Reconstruction Using an Innervated Abdominal Wall Vascularized Composite Tissue Allograft: A Cadaveric Study and Review of the Literature

“…This allowed for a multilayered inset, where the alloflap provides the bulk of superficial and peritoneal coverage and the recipient provides for functional external and internal oblique coverage laterally (►Figs. 11,12).…”

“…[9][10][11][12][13][14][15] However, in contrast to other forms of vascularized composite allotransplantation (VCA), such as hand and face allografts, AW-VCA has never been performed in patients who are not already receiving immunosuppression for a solid organ or multivisceral transplants. 12 The reason that AW-VCA has never been offered to patients not already receiving another transplant is multifactorial.…”

Liver and Vascularized Posterior Rectus Sheath Fascia Composite Tissue Allotransplantation

“…In all patients, primary abdominal wall closure was anticipated to be unlikely. The section of donor abdominal wall consisted of rectus abdominus muscle with investing fascia and overlying subcutaneous tissue and skin, and transplantation required separate anastomoses between the donor deep inferior epigastric vessels and recipient iliac or epigastric vessels (5)(6)(7)(8). Patients in both series received a standard immunosuppression regimen consisting of induction with alemtuzumab and maintenance with tacrolimus.…”

“…Current management techniques for achieving abdominal wall closure include the use of a prosthetic or biologic patch or autologous tissue flaps (1)(2)(3)(4). Recently abdominal wall transplantation has been successfully described for adult and pediatric small bowel and multivisceral organ recipients with large abdominal wall defects or donor/recipient size mismatch (5)(6)(7)(8). Here we describe the novel use of vascularized donor abdominal wall posterior rectus sheath fascia, as a composite tissue allotransplant (CTA), to achieve abdominal wall closure in a liver and double kidney pediatric recipient whose abdominal wall fascia could not be closed primarily due to donor/recipient size mismatch.…”