Failure of abdominal wall closure after intestinal transplantation: Identifying high‐risk recipients

Cloonan, Madeline R.; Fortina, Chaeli A.; Mercer, David F.; Vargas, Luciano; Grant, Wendy J.; Langnas, Alan Norman; Merani, Shaheed

doi:10.1111/ctr.13713

Cited by 4 publications

(5 citation statements)

References 17 publications

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“…It will be crucial to develop objective and reproducible risk stratification tools that combine patient factors (such as the presence of enterocutaneous fistulae and graft type) as well as radiological abdominal measurements [3 ▪ ,29 ▪ ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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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Section: Discussionmentioning

confidence: 99%

“…Cloonan et al have published a case series analysing abdominal closure in paediatric and adult intestinal transplantation (ITx) patients [3 ▪ ]. They identified several recipient risk factors for failing to achieve primary closure.…”

Section: Introductionmentioning

confidence: 99%

Closing the abdomen: update on the current surgical toolkit

Amin

Canovai²

2022

Current Opinion in Organ Transplantation

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“…The inability to achieve primary closure of the abdominal wall after intestinal transplantation (ITx) has led to the development of new strategies to augment closure in these complex cases 1 . Abdominal wall‐vascularized composite allotransplantation (AW‐VCA) was successfully proposed in 2001 to provide abdominal coverage for patients after ITx 2 .…”

Section: Introductionmentioning

confidence: 99%

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

Kuo

Chen

Yeh

et al. 2023

The Kaohsiung J of Med Scie

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In order to accurately monitor graft immunology, we have developed a method for performing intestine and abdominal wall transplantation heterotopically in miniature swine. The procedure consisted of simultaneous segmental terminal ileum and full‐thickness abdominal wall transplantation in Lanyu miniature swine, with the intestinal and the abdominal wall grafts being placed on the recipient's bilateral rear flank. Five transplantations were technically successful. One animal died on the first post‐transplant day due to anesthesia‐related issues, three abdominal wall and four intestinal grafts survived, while one abdominal wall graft failed due to vascular thrombosis. Acute cellular rejection (ACR) of the intestinal graft could occur preceding, simultaneously with or following ACR of the abdominal wall graft. Our experimental model demonstrates the technical feasibility of heterotopic intestine and abdominal wall transplantation in miniature swine without grafting in gastrointestinal continuity. This model could be suitable for further studies of graft immunology.

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“…In addition, transplantation itself causes edema of donor organ(s) and recipient's abdominal wall which only aggravates the size mismatch. The nonability to close the abdomen is mainly a problem in ITx and MVTx, and occurs in 20 to 85% of patients [1,3,4,[6][7][8][9][10][11][12]. However, closing the abdominal wall is important since the presence of an open abdomen is associated with an estimated morbidity up to 50% and mortality of 10% [3].…”

Section: Introductionmentioning

confidence: 99%