Research progress of allogeneic abdominal wall transplantation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Tong , GAO Botao , YU Zhou ,  SONG Baoqiang

Department of Plastic Surgery, the First Affiliated Hospital of Air Force Medical University, Xi’an Shaanxi, 710032, P. R. China;

Corresponding author：

SONG Baoqiang, Email: Songbq2012@163.com

Keywords：

Abdominal wall transplantation; vascularized composite allotransplantation; intestinal transplantation; multivisceral transplantation

DOI：

10.7507/1002-1892.202302077

Video：

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Objective To summarize the research progress of surgical technique and immunosuppressive regimen of abdominal wall vascularized composite allograft transplantation in animals and clinical practice. Methods The literature on abdominal wall transplantation at home and abroad in recent years was extensively reviewed and analyzed. Results This review includes animal and clinical studies. In animal studies, partial or total full-thickness abdominal wall transplantation models have been successfully established by researchers. Also, the use of thoracolumbar nerves has been described as an important method for functional reconstruction and prevention of long-term muscle atrophy in allogeneic abdominal wall transplantation. In clinical studies, researchers have utilized four revascularization techniques to perform abdominal wall transplantation, which has a high survival rate and a low incidence of complications. Conclusion Abdominal wall allotransplantation is a critical reconstructive option for the difficulty closure of complex abdominal wall defects. Realizing the recanalization of the nerve in transplanted abdominal wall to the recipient is very important for the functional recovery of the allograft. The developments of similar research are beneficial for the progress of abdominal wall allotransplantation.

Citation： WANG Tong, GAO Botao, YU Zhou, SONG Baoqiang. Research progress of allogeneic abdominal wall transplantation. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(7): 901-906. doi: 10.7507/1002-1892.202302077 Copy

1.	Fortunato AC, Pinheiro RS, Matsumoto CS, et al. Techniques for closing the abdominal wall in intestinal and multivisceral transplantation: A systematic review. Ann Transplant, 2022, 27: e934595. doi: 10.12659/AOT.934595.
2.	Bauder A, Othman S, Asaad M, et al. Microvascular free tissue transfer for reconstruction of complex abdominal wall defects. Plast Reconstr Surg, 2022, 149(1): 74e-78e.
3.	Reed LT, Echternacht SR, Shanmugarajah K, et al. Twenty years of abdominal wall allotransplantation: A systematic review of the short- and long-term outcomes. Plast Reconstr Surg, 2022, 150(5): 1062e-1070e.
4.	Atia A, Hollins A, Erdmann RF, et al. Synchronous abdominal wall and small-bowel transplantation: A 1-year follow-up. Plast Reconstr Surg Glob Open, 2020, 8(7): e2995. doi: 10.1097/GOX.0000000000002995.
5.	Patel NG, Ratanshi I, Buchel EW. The best of abdominal wall reconstruction. Plast Reconstr Surg, 2018, 141(1): 113e-136e.
6.	Berli JU, Broyles JM, Lough D, et al. Current concepts and systematic review of vascularized composite allotransplantation of the abdominal wall. Clin Transplant, 2013, 27(6): 781-789.
7.	Pezzuto F, Lunardi F, Vadori M, et al. Chronic lung allograft pathology lesions in two rat strain combinations. J Thorac Dis, 2021, 13(5): 2833-2843.
8.	Oltean M. Intestinal transplantation: an overview of the recent experimental studies. Curr Opin Organ Transplant, 2021, 26(2): 240-244.
9.	Quigley MA, Fletcher DR, Zhang W, et al. Development of a reliable model of total abdominal wall transplantation. Plast Reconstr Surg, 2013, 132(4): 988-994.
10.	Lao WW, Wang YL, Ramirez AE, et al. A new rat model for orthotopic abdominal wall allotransplantation. Plast Reconstr Surg Glob Open, 2014, 2(4): e136. doi: 10.1097/GOX.0000000000000086.
11.	Broyles JM, Sarhane KA, Tuffaha SH, et al. Reconstruction of large abdominal wall defects using neurotized vascular composite allografts. Plast Reconstr Surg, 2015, 136(4): 728-737.
12.	Ramirez AE, Cheng HY, Lao WW, et al. A novel rat full-thickness hemi-abdominal wall/hindlimb osteomyocutaneous combined flap: influence of allograft mass and vascularized bone marrow content on vascularized composite allograft survival. Transpl Int, 2014, 27(9): 977-986.
13.	Greenfield EA. Administering anesthesia to mice, rats, and hamsters. Cold Spring Harb Protoc, 2019. doi: 10.1101/pdb.prot100198.
14.	Rufiange M, Leung VSY, Simpson K, et al. Pre-warming before general anesthesia with isoflurane delays the onset of hypothermia in rats. PLoS One, 2020, 15(3): e0219722. doi: 10.1371/journal.pone.0219722.
15.	Yang P, Du Y, Zeng H, et al. Comparison of inflammatory markers between the sevoflurane and isoflurane anesthesia in a rat model of liver ischemia/reperfusion injury. Transplant Proc, 2019, 51(6): 2071-2075.
16.	Wang X, Parapanov R, Francioli C, et al. Experimental ex vivo lung perfusion with sevoflurane: effects on damaged donor lung grafts. Interact Cardiovasc Thorac Surg, 2018, 26(6): 977-984.
17.	Stringa P, Arreola NM, Moreno AMA, et al. Modified multivisceral transplantation with native spleen removal in rats. Eur J Pediatr Surg, 2019, 29(3): 253-259.
18.	Foster RD, Pham S, Li S, et al. Long-term acceptance of composite tissue allografts through mixed chimerism and CD28 blockade. Transplantation, 2003, 76(6): 988-994.
19.	Larsen M, Friedrich PF, Bishop AT. A modified vascularized whole knee joint allotransplantation model in the rat. Microsurgery, 2010, 30(7): 557-564.
20.	Tuffaha S, Quigley M, Ng T, et al. The effect of chondroitinase on nerve regeneration following composite tissue allotransplantation. J Hand Surg (Am), 2011, 36(9): 1447-1452.
21.	Zuo KJ, Shafa G, Chan K, et al. Local FK506 drug delivery enhances nerve regeneration through fresh, unprocessed peripheral nerve allografts. Exp Neurol, 2021, 341: 113680. doi: 10.1016/j.expneurol.2021.113680.
22.	Jeong Y, Choi W, Kim JH, et al. Histomorphometric analysis of femoral and sciatic nerve regeneration in a rat hindlimb allotransplantation model. Transplant Proc, 2022, 54(2): 503-506.
23.	Lin CH, Anggelia MR, Cheng HY, et al. The intragraft vascularized bone marrow component plays a critical role in tolerance induction after reconstructive transplantation. Cell Mol Immunol, 2021, 18(2): 363-373.
24.	Levi DM, Tzakis AG, Kato T, et al. Transplantation of the abdominal wall. Lancet, 2003, 361(9376): 2173-2176.
25.	Selvaggi G, Levi DM, Cipriani R, et al. Abdominal wall transplantation: surgical and immunologic aspects. Transplant Proc, 2009, 41(2): 521-522.
26.	Giele H, Bendon C, Reddy S, et al. Remote revascularization of abdominal wall transplants using the forearm. Am J Transplant, 2014, 14(6): 1410-1416.
27.	Mannu GS, Vaidya A. An interesting rash following bowel and abdominal wall transplantation. BMJ Case Rep, 2013, 2013: bcr2013200951. doi: 10.1136/bcr-2013-200951.
28.	Mannu GS, Vaidya A. Graft versus host disease following small bowel and abdominal wall transplantation. BMJ Case Rep, 2014, 2014: bcr2014205983. doi: 10.1136/bcr-2014-205983.
29.	Gerlach UA, Vrakas G, Sawitzki B, et al. Abdominal wall transplantation: Skin as a sentinel marker for rejection. Am J Transplant, 2016, 16(6): 1892-1900.
30.	Weissenbacher A, Vrakas G, Chen M, et al. De novo donor-specific HLA antibodies after combined intestinal and vascularized composite allotransplantation-a retrospective study. Transpl Int, 2018, 31(4): 398-407.
31.	Allin BS, Ceresa CD, Issa F, et al. A single center experience of abdominal wall graft rejection after combined intestinal and abdominal wall transplantation. Am J Transplant, 2013, 13(8): 2211-2215.
32.	Cipriani R, Contedini F, Santoli M, et al. Abdominal wall transplantation with microsurgical technique. Am J Transplant, 2007, 7(5): 1304-1307.
33.	Lauro A, Zanfi C, Ercolani G, et al. Twenty-five consecutive isolated intestinal transplants in adult patients: a five-yr clinical experience. Clin Transplant, 2007, 21(2): 177-185.
34.	Lauro A, Arpinati M, Zanfi C, et al. Extracorporeal photopheresis for chronic GVHD: case report after adult bowel-abdominal wall transplantation. Transplantation, 2013, 96(2): e9-e10.
35.	Giele H, Vaidya A, Reddy S, et al. Current state of abdominal wall transplantation. Curr Opin Organ Transplant, 2016, 21(2): 159-164.
36.	Park SH, Eun SC. Abdominal wall transplant surgery. Exp Clin Transplant, 2018, 16(6): 745-750.
37.	Trentadue G, Kats-Ugurlu G, Blokzijl T, et al. Safe and successful treatment of acute cellular rejection of an intestine and abdominal wall transplant with vedolizumab. Transplant Direct. 2020, 6(2): e527. doi: 10.1097/TXD.0000000000000973.
38.	Erdmann D, Atia A, Phillips BT, et al. Small bowel and abdominal wall transplantation: A novel technique for synchronous revascularization. Am J Transplant, 2019, 19: 2122-2126.
39.	Atia A, Hollins A, Shammas R, et al. Surgical techniques for revascularization in abdominal wall transplantation. J Reconstr Microsurg, 2020, 36(7): 522-527.
40.	Light D, Kundu N, Djohan R, et al. Total abdominal wall transplantation: An anatomical study and classification system. Plast Reconstr Surg, 2017, 139(6): 1466-1473.
41.	Huang WC, Lin JY, Wallace CG, et al. Vascularized bone grafts within composite tissue allotransplants can autocreate tolerance through mixed chimerism with partial myeloablative conditioning: an experimental study in rats. Plast Reconstr Surg, 2010, 125(4): 1095-1103.

1. Fortunato AC, Pinheiro RS, Matsumoto CS, et al. Techniques for closing the abdominal wall in intestinal and multivisceral transplantation: A systematic review. Ann Transplant, 2022, 27: e934595. doi: 10.12659/AOT.934595.
2. Bauder A, Othman S, Asaad M, et al. Microvascular free tissue transfer for reconstruction of complex abdominal wall defects. Plast Reconstr Surg, 2022, 149(1): 74e-78e.
3. Reed LT, Echternacht SR, Shanmugarajah K, et al. Twenty years of abdominal wall allotransplantation: A systematic review of the short- and long-term outcomes. Plast Reconstr Surg, 2022, 150(5): 1062e-1070e.
4. Atia A, Hollins A, Erdmann RF, et al. Synchronous abdominal wall and small-bowel transplantation: A 1-year follow-up. Plast Reconstr Surg Glob Open, 2020, 8(7): e2995. doi: 10.1097/GOX.0000000000002995.
5. Patel NG, Ratanshi I, Buchel EW. The best of abdominal wall reconstruction. Plast Reconstr Surg, 2018, 141(1): 113e-136e.
6. Berli JU, Broyles JM, Lough D, et al. Current concepts and systematic review of vascularized composite allotransplantation of the abdominal wall. Clin Transplant, 2013, 27(6): 781-789.
7. Pezzuto F, Lunardi F, Vadori M, et al. Chronic lung allograft pathology lesions in two rat strain combinations. J Thorac Dis, 2021, 13(5): 2833-2843.
8. Oltean M. Intestinal transplantation: an overview of the recent experimental studies. Curr Opin Organ Transplant, 2021, 26(2): 240-244.
9. Quigley MA, Fletcher DR, Zhang W, et al. Development of a reliable model of total abdominal wall transplantation. Plast Reconstr Surg, 2013, 132(4): 988-994.
10. Lao WW, Wang YL, Ramirez AE, et al. A new rat model for orthotopic abdominal wall allotransplantation. Plast Reconstr Surg Glob Open, 2014, 2(4): e136. doi: 10.1097/GOX.0000000000000086.
11. Broyles JM, Sarhane KA, Tuffaha SH, et al. Reconstruction of large abdominal wall defects using neurotized vascular composite allografts. Plast Reconstr Surg, 2015, 136(4): 728-737.
12. Ramirez AE, Cheng HY, Lao WW, et al. A novel rat full-thickness hemi-abdominal wall/hindlimb osteomyocutaneous combined flap: influence of allograft mass and vascularized bone marrow content on vascularized composite allograft survival. Transpl Int, 2014, 27(9): 977-986.
13. Greenfield EA. Administering anesthesia to mice, rats, and hamsters. Cold Spring Harb Protoc, 2019. doi: 10.1101/pdb.prot100198.
14. Rufiange M, Leung VSY, Simpson K, et al. Pre-warming before general anesthesia with isoflurane delays the onset of hypothermia in rats. PLoS One, 2020, 15(3): e0219722. doi: 10.1371/journal.pone.0219722.
15. Yang P, Du Y, Zeng H, et al. Comparison of inflammatory markers between the sevoflurane and isoflurane anesthesia in a rat model of liver ischemia/reperfusion injury. Transplant Proc, 2019, 51(6): 2071-2075.
16. Wang X, Parapanov R, Francioli C, et al. Experimental ex vivo lung perfusion with sevoflurane: effects on damaged donor lung grafts. Interact Cardiovasc Thorac Surg, 2018, 26(6): 977-984.
17. Stringa P, Arreola NM, Moreno AMA, et al. Modified multivisceral transplantation with native spleen removal in rats. Eur J Pediatr Surg, 2019, 29(3): 253-259.
18. Foster RD, Pham S, Li S, et al. Long-term acceptance of composite tissue allografts through mixed chimerism and CD28 blockade. Transplantation, 2003, 76(6): 988-994.
19. Larsen M, Friedrich PF, Bishop AT. A modified vascularized whole knee joint allotransplantation model in the rat. Microsurgery, 2010, 30(7): 557-564.
20. Tuffaha S, Quigley M, Ng T, et al. The effect of chondroitinase on nerve regeneration following composite tissue allotransplantation. J Hand Surg (Am), 2011, 36(9): 1447-1452.
21. Zuo KJ, Shafa G, Chan K, et al. Local FK506 drug delivery enhances nerve regeneration through fresh, unprocessed peripheral nerve allografts. Exp Neurol, 2021, 341: 113680. doi: 10.1016/j.expneurol.2021.113680.
22. Jeong Y, Choi W, Kim JH, et al. Histomorphometric analysis of femoral and sciatic nerve regeneration in a rat hindlimb allotransplantation model. Transplant Proc, 2022, 54(2): 503-506.
23. Lin CH, Anggelia MR, Cheng HY, et al. The intragraft vascularized bone marrow component plays a critical role in tolerance induction after reconstructive transplantation. Cell Mol Immunol, 2021, 18(2): 363-373.
24. Levi DM, Tzakis AG, Kato T, et al. Transplantation of the abdominal wall. Lancet, 2003, 361(9376): 2173-2176.
25. Selvaggi G, Levi DM, Cipriani R, et al. Abdominal wall transplantation: surgical and immunologic aspects. Transplant Proc, 2009, 41(2): 521-522.
26. Giele H, Bendon C, Reddy S, et al. Remote revascularization of abdominal wall transplants using the forearm. Am J Transplant, 2014, 14(6): 1410-1416.
27. Mannu GS, Vaidya A. An interesting rash following bowel and abdominal wall transplantation. BMJ Case Rep, 2013, 2013: bcr2013200951. doi: 10.1136/bcr-2013-200951.
28. Mannu GS, Vaidya A. Graft versus host disease following small bowel and abdominal wall transplantation. BMJ Case Rep, 2014, 2014: bcr2014205983. doi: 10.1136/bcr-2014-205983.
29. Gerlach UA, Vrakas G, Sawitzki B, et al. Abdominal wall transplantation: Skin as a sentinel marker for rejection. Am J Transplant, 2016, 16(6): 1892-1900.
30. Weissenbacher A, Vrakas G, Chen M, et al. De novo donor-specific HLA antibodies after combined intestinal and vascularized composite allotransplantation-a retrospective study. Transpl Int, 2018, 31(4): 398-407.
31. Allin BS, Ceresa CD, Issa F, et al. A single center experience of abdominal wall graft rejection after combined intestinal and abdominal wall transplantation. Am J Transplant, 2013, 13(8): 2211-2215.
32. Cipriani R, Contedini F, Santoli M, et al. Abdominal wall transplantation with microsurgical technique. Am J Transplant, 2007, 7(5): 1304-1307.
33. Lauro A, Zanfi C, Ercolani G, et al. Twenty-five consecutive isolated intestinal transplants in adult patients: a five-yr clinical experience. Clin Transplant, 2007, 21(2): 177-185.
34. Lauro A, Arpinati M, Zanfi C, et al. Extracorporeal photopheresis for chronic GVHD: case report after adult bowel-abdominal wall transplantation. Transplantation, 2013, 96(2): e9-e10.
35. Giele H, Vaidya A, Reddy S, et al. Current state of abdominal wall transplantation. Curr Opin Organ Transplant, 2016, 21(2): 159-164.
36. Park SH, Eun SC. Abdominal wall transplant surgery. Exp Clin Transplant, 2018, 16(6): 745-750.
37. Trentadue G, Kats-Ugurlu G, Blokzijl T, et al. Safe and successful treatment of acute cellular rejection of an intestine and abdominal wall transplant with vedolizumab. Transplant Direct. 2020, 6(2): e527. doi: 10.1097/TXD.0000000000000973.
38. Erdmann D, Atia A, Phillips BT, et al. Small bowel and abdominal wall transplantation: A novel technique for synchronous revascularization. Am J Transplant, 2019, 19: 2122-2126.
39. Atia A, Hollins A, Shammas R, et al. Surgical techniques for revascularization in abdominal wall transplantation. J Reconstr Microsurg, 2020, 36(7): 522-527.
40. Light D, Kundu N, Djohan R, et al. Total abdominal wall transplantation: An anatomical study and classification system. Plast Reconstr Surg, 2017, 139(6): 1466-1473.
41. Huang WC, Lin JY, Wallace CG, et al. Vascularized bone grafts within composite tissue allotransplants can autocreate tolerance through mixed chimerism with partial myeloablative conditioning: an experimental study in rats. Plast Reconstr Surg, 2010, 125(4): 1095-1103.

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Research progress of allogeneic abdominal wall transplantation

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