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Digestive Disease Interventions 2020; 04(03): 273-281
DOI: 10.1055/s-0040-1715810
Review Article

The Role of Visceral Transplantation for Neoplastic Disease

Masato Fujiki 
1   Department of General Surgery, Center of Gut Rehabilitation and Transplantation, Cleveland Clinic, Cleveland, Ohio
,
Amit Nair 
1   Department of General Surgery, Center of Gut Rehabilitation and Transplantation, Cleveland Clinic, Cleveland, Ohio
,
Giuseppe D'amico
1   Department of General Surgery, Center of Gut Rehabilitation and Transplantation, Cleveland Clinic, Cleveland, Ohio
,
Mohammed Osman
1   Department of General Surgery, Center of Gut Rehabilitation and Transplantation, Cleveland Clinic, Cleveland, Ohio
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Abstract

Visceral transplantation has been utilized as the most radical surgical treatment for neoplasms not amenable to conventional resection. The main indications for this procedure include mesenteric desmoid tumors threatening the root of mesentery and metastatic neuroendocrine neoplasms. Published case-series of visceral transplantation for such indications are reviewed in this article. Patients with desmoid tumors associated with familial adenomatous polyposis are transplanted with intestinal or multivisceral allografts. With surgical modification of technique, the native spleen is preserved while duodenopancreatic complex is removed to obviate the risk of malignant transformation of duodenal polyposis after transplantation. Preservation of spleen decreased incidence of post-transplant lymphoproliferative disorder, conferring therapeutic advantage. Patient survival is comparable to that of other indications, and desmoid tumor recurrence has been observed in the recipient tissue but not in the donor allograft. For visceral transplantation of metastatic neuroendocrine neoplasms, the majority of these patients have diffuse liver involvement, thus requiring full multivisceral transplantation. Post-transplant patient survival is acceptable with limited data available on recurrence. Autotransplantation following ex vivo tumor resection using visceral allografts has been also performed in a limited, select cohort of patients with various pathologies. Adenocarcinomas are associated with a prohibitive recurrence rate following the procedure, and its use for this indication is therefore not recommended. A national database of visceral transplantation undertaken for neoplastic disease should be developed to better understand predictors of outcomes and to help produce and standardize selection criteria.

Keywords

intestinal and multivisceral transplantation - autotransplantation - disease recurrence - desmoid tumor - neuroendocrine neoplasm


Publication History

Received: 07 January 2020

Accepted: 08 June 2020

Article published online:
27 August 2020

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.

 

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