Abdominal Wall Transplantation
Abdominal wall vascularized composite allotransplantation (AW-VCA) is a relatively young field within transplantation with 21 reported cases to date in the last decade. All AW-VCAs have been performed on patients undergoing either simultaneous multivisceral transplantation (MVT) or intestinal transplantation (IT). The two approaches to AW-VCA described are macrovascular and microvascular approaches. While at the time that this review is written, only three institutions have performed this procedure; their outcomes have shown low allograft loss. In addition, acute rejection of the abdominal wall graft was uncommon and successfully treated with standard measures. A comparison of each institution’s operative technique, maintenance immunosuppression regimen, and rejection management provide insight regarding the feasibility of AW-VCAs. AW-VCA has proven to serve as a viable option for patients undergoing multivisceral or intestinal transplantation with a donor and recipient size mismatch. Further experience with AW-VCA will aid in better defining its indications and help standardize technique and management.