Clinical analysis of combined ‘en bloc’ liver and pancreas transplantation in patient with upper abdominal multiple organ disease: a report of 14 cases

Abstract

Objective To investigate the clinical efficacy of liver-duodeno-pancreatic organ cluster transplantation in patients with upper abdominal malignancy and in patients with end-stage liver disease and type 2 diabetes.Method The clinical data of 14 cases of liver-duodeno-pancreatic organ cluster transplantation were retrospectively analyzed.Five patients (group A) who suffered from unresectable advanced upper abdominal malignancy,experienced the liver,stomach,spleen,pancreas,duodenum,omentum and variable amounts of the colon resection,and then underwent standard multivisceral transplantation (including liver,stomach,pancreatodoudenal and small bowel).Besides,7 cases (group B) of liver-duodeno-pancreatic organ cluster transplantation suffered from end-stage liver disease and type 2 diabetes mellitus.The pancreas and the whole digestive tract of the recipients were reserved.The liver and pancreas duodenal organ cluster grafts were implanted after the resection of the liver.Result From one to seven days after operations,no insulin was used in all the patients,and the blood glucose levels returned to almost normal.Alanine aminotransferase (ALT),aspartate aminotransferase (AST) and total bilirubin became normal after 1 week.C peptide levels reached the normal range in 1 to 2 weeks.For the 5 patients in group A,the longest survival period was 326 days.The dead causes included recurrent tumor (n =2),and multiple organ failure (MODS,n =3).Among the 9 patients in group B,one died of graft-versus-host disease in 1 month after operation,one died of acute monocytic leukemia,two suffered from pulmonary infection,one suffered from intestinal fistula which was came from pancreatic leakage,and no obvious complications were observed in the remaining patients.During the follow-up period,the longest survival time was more than 39 months,liver and pancreatic grafts function was normal,and patients' quality of life was good.Conclusion The best indication for combined en bloc' liver and pancreas transplantation is end-stage liver disease combined with type 2 diabetes mellitus.Liver-duodeno-pancreatic organ cluster transplantation is technically feasible and is an effective method for the treatment of end-stage liver disease with type 2 diabetes mellitus. Key words: Abdomen; Organ transplantation; Liver cirrhosis; Diabetes mellitus, type 2