Allotransplantation of donor rectus fascia for abdominal wall closure in transplant patients: A systematic review

Janssen, Yveline; Winkel, Nele Van De; Pirenne, Jacques; Ceulemans, Laurens J.; Miserez, Marc

doi:10.1016/j.trre.2021.100634

Cited by 11 publications

(20 citation statements)

References 22 publications

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“…Fascia is generally considered poorly immunogenic (12), and preservation of vascularized fascia through the falciform ligament has been demonstrated in multivisceral transplantation This article is protected by copyright. All rights reserved.…”

Section: Immunologic Rejection Of Vascularized Abdominal Fasciamentioning

confidence: 99%

See 1 more Smart Citation

Synchronous Abdominal Wall and Small Bowel Transplantation: Critical Insights at 4-Year Follow-up

Oleck,

Erdmann,

Ravindra

et al. 2024

J Reconstr Microsurg Open

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This four-year follow-up of synchronous abdominal wall allotransplantation (AW-VCA) and small bowel transplantation reveals novel insights and innovations in abdominal wall VCA. The case, involving a 37-year-old male Army veteran, showcases the benefits of AW-VCA in addressing loss of abdominal domain in intestinal transplantation (ITx). The events leading to ultimate rejection of both the AW-VCA and small bowel graft at four years highlights the complex interplay between graft survival, patient compliance, and immunosuppressive management. Notably, a significant discordance between AW-VCA and ITx rejection patterns was identified, questioning the reliability of skin components in AW-VCA as early indicators of ITx rejection. Furthermore, the behavior of the vascularized abdominal fascia, observed post-excision of the small bowel graft, offers new understanding of the immunologic response to fascia-only grafts. This follow-up emphasizes the complexities of graft survival, patient compliance, and immunosuppressive management, underscoring the need for ongoing research and innovation in the field.

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Section: Immunologic Rejection Of Vascularized Abdominal Fasciamentioning

confidence: 99%

“…without alterations in immunosuppression (12,13). However, in these cases a separate microvascular anastomosis is not performed, and the vascularized fascia cannot be assessed independent of the visceral graft.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Synchronous Abdominal Wall and Small Bowel Transplantation: Critical Insights at 4-Year Follow-up

Oleck,

Erdmann,

Ravindra

et al. 2024

J Reconstr Microsurg Open

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“…Alternatively, the implementation of several techniques to expand the abdominal wall after transplantation [e.g. (non) vascularized fascia or full-thickness abdominal wall transplant] also allows the use of larger grafts [16,17 ▪ ]. Especially in case of multivisceral transplantation or chronic pseudo-obstruction, size-mismatch has safely been performed, because of the preserved abdominal domain in these patients [15].…”

Section: Extended Donor Criteriamentioning

confidence: 99%

Potential options to expand the intestinal donor pool: a comprehensive review

Clarysse

Dubois

Vanuytsel

et al. 2022

Current Opinion in Organ Transplantation

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Purpose of reviewIntestinal donation is currently restricted to ‘perfect’ donors, as the intestine is extremely vulnerable to ischemia. With generally deteriorating donor quality and increasing indications for intestinal transplantation (ITx), the potential to safely increase the donor pool should be evaluated.Recent findingsIncreasing awareness on intestinal donation (often forgotten) and cautiously broadening the strict donor criteria (increasing age, resuscitation time and ICU stay) could expand the potential donor pool. Donors after circulatory death (DCD) have so far not been considered for ITx, due to the particularly detrimental effect of warm ischemia on the intestine. However, normothermic regional perfusion might be a well tolerated strategy to render the use of DCD intestinal grafts feasible. Furthermore, machine perfusion is under continuous development and might improve preservation of the intestine and potentially offer a platform to modulate the intestinal graft. Lastly, living donation currently represents only a minority of all ITxs performed worldwide. Various studies and registry analysis show that it can be performed safely for the donor and successfully in the recipient.SummarySeveral potential strategies are available to expand the current intestinal donor pool. Most of them require further investigation or technical developments before they can be implemented in the clinical routine.

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“…To date, no mortality or loss of grafts have been ascribed due to the use of NVRF [10,11,12 ▪▪ ]. In Gondolesi's et al initial paper, overall superficial wound infections were reported at 44% with the use of NVRF.…”

Section: Non-vascularised Rectus Fasciamentioning

confidence: 99%

“…The main advantages are that it obviates the need for any additional vascular anastomoses and the simultaneous reperfusion of the VRF with the liver-intestinal graft. However, it can only be used in liver-containing grafts, making the donor and implant surgery more challenging (as the falciform and triangular ligament have to be left intact) and the hepatic falciform artery is not always present [12 ▪▪ ].…”

Section: Vascularised Rectus Fasciamentioning

confidence: 99%

Closing the abdomen: update on the current surgical toolkit

Amin

Canovai²

2022

Current Opinion in Organ Transplantation

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Purpose of reviewAchieving abdominal wall closure after intestinal transplantation (ITx) is one of the crucial surgical challenges. This problem is present in 25–50% of all transplants due to reduction in abdominal domain, fistulae and extensive adhesions due to previous surgeries. Failure to achieve closure is an independent risk factor for mortality and graft loss. The aim of this paper is to summarize the current options to achieve this.Recent findingsSuccessful closure of the abdomen requires a tension-free repair. Primary closure of the fascia can be reinforced with synthetic or biological mesh. For more complex fascial defects bridging mesh, nonvascularised or vascularised rectus fascia can be utilised. If all components of the abdominal wall are affected, then a full-thickness abdominal wall transplantation may be necessary.SummaryA variety of successful techniques have been described by different groups to enable abdominal wall closure after ITx. Emerging developments in preoperative imaging, reconstructive surgery and immunology have expanded the surgical toolkit available. Crucial is a tailor-made approach whereby patients with expected closure issues are identified prior to surgery and the simplest technique is chosen.

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Allotransplantation of donor rectus fascia for abdominal wall closure in transplant patients: A systematic review

Cited by 11 publications

References 22 publications

Synchronous Abdominal Wall and Small Bowel Transplantation: Critical Insights at 4-Year Follow-up

Synchronous Abdominal Wall and Small Bowel Transplantation: Critical Insights at 4-Year Follow-up

Potential options to expand the intestinal donor pool: a comprehensive review

Closing the abdomen: update on the current surgical toolkit

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