Multivisceral Transplantation as curative Treatment for patients with Diffuse Splanchnic Arterial Ischemia: a case report

Background: Criteria for multivisceral transplantation (MVTx) have broadened. However, diffuse splanchnic arterial ischemia secondary to visceral arterial thrombosis has only been described once. Case report: A 46-year-old woman with acute-on-chronic diffuse splanchnic ischemia received a MVTx from a 14-year-old braindead donor. Cold ischemia time was 6h29, warm ischemia time 0h36. Pre-operative embolization of inferior mesenteric artery was performed and the patient was placed on continuous veno-venous hemofiltration. An aortic conduit was constructed. Non-vascularized-rectus-fascia transplantation was performed. Postoperative course was hindered by kinking of superior mesenteric artery (SMA) (requiring stenting), acute cellular rejection of intestine (early) and liver (late) (requiring high-dose solumedrol) and esophagogastric anastomotic leakage (requiring endoscopic vacuum assisted closure). At 11 months, she is alive and well. She is able to have oral intake. Conclusion: MVTx is a curative treatment for diffuse arterial splanchnic ischemia secondary to thrombosis of both the coeliac trunk and the SMA, a condition otherwise rapidly fatal.