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First abdominal wall transplant in Belgium at UZ Leuven

24 January 2022

At UZ Leuven, two intestinal transplant patients successfully received a new abdominal wall. This is remarkable, because such an operation has only been performed about fifty times worldwide to date.

UZ Leuven

The technique for that transplant, which involves transplanting the peritoneum and tendon from the six-pack of a deceased donor, helps to prevent an open abdomen after organ transplantation. An abdominal wall transplant is not performed for aesthetic reasons: it is a necessary but extremely delicate procedure for patients in need of an intestinal or multivisceral transplant. In other words: a new stomach, liver, pancreas and small intestine at the same time. Such operations occur on average once or twice a year at UZ Leuven.

A recurring challenge is that the abdominal wall can no longer be closed after an intestinal transplant: some of the failing organs have already been surgically removed, making the abdominal wall very rigid and the abdominal cavity shrinking. To be able to close the abdominal wall after a transplant, different techniques were tried for decades, but transplant surgeons had not yet found the golden egg.

Six-pack without muscles

Using a technique developed in the United States and so far only used in about 50 operations around the world, Prof. Dr. Laurens Ceulemans and the intestinal transplant team at UZ Leuven succeeded in performing two successful abdominal wall transplants in patients undergoing multivisceral transplantation in September 2020 and November 2021.

Prof. Dr. Laurens Ceulemans: "The technique involves transplanting the tendon sheets and peritoneum from the six-pack of a deceased donor, without restoring the muscles and blood vessels. This is best compared to transplanting an aortic valve or tendon into the leg."

Professor Ceulemans' team used micro-CT and tissue analysis to show that after the tendon sheets are sutured in, blood flow in the transplanted donor abdominal wall is restarted. "From week 1 after transplantation, we saw small blood vessels forming again in the transplanted abdominal wall. After six months, these formed an entire network with no signs of rejection," said Prof. Ceulemans.

Patients with serious abdominal wall defects

Researchers at UZ Leuven and KU Leuven are currently conducting studies to see whether an abdominal wall transplant can be safely performed without the use of immunosuppressive drugs and how long a donor abdominal wall can be safely stored in the tissue bank. Dr. Nele Van De Winkel (abdominal wall surgeon): "In the long term, the new transplantation technique may also prove potentially useful for patients with a severe abdominal wall defect and fistulas in the intestines such as in patients with Crohn's disease."

Expertise around intestinal failure and intestinal transplantation

UZ Leuven is the first hospital in Belgium to successfully perform abdominal wall transplants. That achievement is the result of focused specialization. Five years ago today, the Leuven Intestinal Failure and Transplantation Center (LIFT) was established, a unique multidisciplinary evaluation center for patients with intestinal failure led by Professor Jacques Pirenne (transplant surgeon) and Professor Tim Vanuytsel (gastroenterologist). To date, 26 intestinal transplants have been performed at UZ Leuven. The center encourages Leuven gastroenterologists, abdominal surgeons and intestinal transplant surgeons to conduct joint research into groundbreaking treatment methods.

Source: UZ Leuven

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