100 Multivisceral Transplants at a Single Center

Multivisceral transplantation is the concurrent transplantation of the stomach, pancreaticoduodenal complex, and intestine, with (MVTx) or without (modified multivisceral [MMVTx]) the liver. “Mass homotransplantation of abdominal organs” was introduced in 19601 as a model to study the behavior of a large denervated homograft in which the lymphatic drainage was interrupted. The boldness of the concept was evident in the cataclysmic postoperative course. The longest survival reported in 19 dogs was 9 days. The first patient to undergo the procedure in 1983 was a previously healthy 6-year-old girl who developed short gut syndrome after a swimming pool accident and was terminally ill from liver failure.2 The child died of hemorrhage immediately after the procedure. No observations beyond the grave technical difficulties were possible. The first 2 patients to survive beyond the immediate postoperative period were reported in 1989.2,3 It was possible to demonstrate normal function of all the organs under cyclosporine immunosuppression. Unfortunately, both patients developed posttransplant lymphoproliferative disorder (PTLD) and died 192 and 109 days after transplantation. The first patient to achieve hospital discharge was transplanted in December 1989.4 He sustained life at home without any parenteral support and died of metastatic pancreatic cancer 10 months after transplantation. The Achilles heel of multivisceral transplantation has been its intestinal component. Indeed, it was not until intestinal acute rejection was more effectively prevented and controlled with tacrolimus that it became clinically feasible.5–7 Notwithstanding this, multivisceral transplantation remains a rare procedure. One hundred seventy cases were reported worldwide through May 2003 (Grant D, Smith R, personal communication, April 5, 2005) and have been blended with the growing experience in intestinal transplantation. This study presents a decade experience with 100 such transplants at the University of Miami/Jackson Memorial Hospital.