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World J Gastrointest Surg. Sep 27, 2017; 9(9): 186-192
Published online Sep 27, 2017. doi: 10.4240/wjgs.v9.i9.186
Role of “reduced-size” liver/bowel grafts in the “abdominal wall transplantation” era
Augusto Lauro, Anil Vaidya
Augusto Lauro, Liver and Multiorgan Transplant Unit, St Orsola University Hospital, 40138 Bologna, Italy
Anil Vaidya, Department of Transplant Surgery, Oxford University Hospital, Oxford OX3 7LE, United Kingdom
Author contributions: Lauro A and Vaidya A equally contributed in designing, performing, analyzing and writing the minireview.
Conflict-of-interest statement: There is no conflict of interest associated with any of the author contributing to this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Augusto Lauro, MD, PhD, Attending Surgeon of the Liver and Multiorgan Transplant Unit, St. Orsola University Hospital-Alma Mater Studiorum, 40138 Bologna, Italy. augusto.lauro@aosp.bo.it
Telephone: +39-51-2143721
Received: January 16, 2017
Peer-review started: January 18, 2017
First decision: March 6, 2017
Revised: March 24, 2017
Accepted: July 7, 2017
Article in press: July 10, 2017
Published online: September 27, 2017
Processing time: 252 Days and 12.2 Hours
Abstract

The evolution of multi-visceral and isolated intestinal transplant techniques over the last 3 decades has highlighted the technical challenges related to the closure of the abdomen at the end of the procedure. Two key factors that contribute to this challenge include: (1) Volume/edema of donor graft; and (2) loss of abdominal domain in the recipient. Not being able to close the abdominal wall leads to a variety of complications and morbidity that range from complex ventral hernias to bowel perforation. At the end of the 90’s this challenge was overcome by graft reduction during the donor operation or bench table procedure (especially reducing liver and small intestine), as well as techniques to increase the volume of abdominal cavity by pre-operative expansion devices. Recent reports from a few groups have demonstrated the ability of transplanting a full-thickness, vascularized abdominal wall from the same donor. Thus, a spectrum of techniques have co-evolved with multi-visceral and intestinal transplantation, ranging from graft reduction to enlarging the volume of the abdominal cavity. None of these techniques are free from complications, however in large-volume centers the combinations of both (graft reduction and abdominal widening, sometimes used in the same patient) could decrease the adverse events related to recipient’s closure, allowing a faster recovery. The quest for a solution to this unique challenge has led to the proposal and implementation of innovative solutions to enlarge the abdominal cavity.

Keywords: Abdominal wall transplant; Reduced-size graft; Combined liver-bowel transplantation

Core tip: Matching donors with recipients to perform liver-bowel transplantation is a challenging task, especially in front of pediatric candidates due to the shortage of suitable donors. Historically, the issue was overcome reducing the size of liver and bowel during donation in order to implant the combined graft in the small abdominal cavity of the recipient. Due to the presence of complications, the procedure has been improved by enlarging the abdominal cavity of the recipients, initially through conventional techniques used in hernia repair or trauma surgery and later by transplanting the donor abdominal wall into the recipient. Results are encouraging but limited to high experienced centers.