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Simultaneous Scalp, Skull, Kidney, and Pancreas Transplant from a Single Donor.

Abstract：

BACKGROUND:Vascularized composite allotransplantation is an emerging field, but the complications of lifelong immunosuppression limit indications. Vascularized composite allotransplantation in solid organ recipients represents a unique opportunity because immunosuppression has already been accepted. This report of a simultaneous scalp, skull, kidney, and pancreas transplant represents both the first skull-scalp transplant and combination of a vascularized composite allotransplantation with double organ transplantation. METHODS:A previous recipient of a kidney-pancreas transplant presented with osteoradionecrosis of the calvaria and a large area of unstable scalp following successful, curative treatment of a scalp tumor. His kidney and pancreas functions were also critically poor. A multidisciplinary, multi-institutional plan was developed to perform a simultaneous scalp, skull, and repeated kidney and pancreas transplantation, all from a single donor. RESULTS:Eighteen months after the patient was listed with the United Network for Organ Sharing, a donor was identified and the multiorgan vascularized composite allotransplantation was performed. Twenty physicians and 15 hours were required to perform donor and recipient procedures. The patient recovered well and was discharged on postoperative day 15. He has had one episode of scalp rejection confirmed by biopsy and treated successfully. His creatinine value is currently 0.8 mg/dl, from 5.0 mg/dl, and his blood glucose levels are normal without supplemental insulin. Aesthetic outcome is very satisfactory. The patient is now 1 year post-transplantation and doing well. CONCLUSIONS:Vascularized composite allotransplantation in solid organ recipients is an expansion of current indications to already immunosuppressed patients. Rejection of the vascularized composite allotransplant without solid organ rejection can occur and is treatable. Methodical planning, an interdisciplinary approach, and careful management of all organs are critical to success. CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, V.

journal_name

Plast Reconstr Surg

journal_title

Plastic and reconstructive surgery

authors

Selber JC,Chang EI,Clemens MW,Gaber L,Hanasono MM,Klebuc M,Skoracki RJ,Trask T,Yu P,Gaber AO

doi

10.1097/PRS.0000000000002153

subject

Has Abstract

pub_date

2016-06-01 00:00:00

pages

1851-1861

issue

eissn

0032-1052

issn

1529-4242

pii

00006534-201606000-00036

journal_volume

137

pub_type

杂志文章

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Simultaneous Scalp, Skull, Kidney, and Pancreas Transplant from a Single Donor.