Objectives: Various postoperatively complications and high mortality rate are the major difficulties in early classical total and subtotal abdominal organ transplantation. To improve long-term survival, we conducted improvements and innovations of key technologies, including arterial reconstruction, digestive tract reconstruction, preserving pancreas, jointly mutiple organ harvest and immunosuppression, and summarized effect of modified upper abdominal organ cluster transplantation.

Methods: The data from a serial of 16 cases received modifid upper abdominal organ cluster transplantation was summarized retrospectively. The protopathy included 8 cases with hepatitis B relatived cirrhosis, 6 cases with hepatocellular carcinoma, 1 case with cholangiocarcinoma and 1 case with alcoholic cirrhosis. All cases were combined with type 2 diabetes mellitus and used insulin preoperative to control blood sugar. After preserving original pancreas and whole digestive tract, as well as only liver resection, the allografts including liver, pancreas and duodenal descending part and horizontal part were transplanted intraoperatively. A quadruple immunosuppressive regimen was conducted, including induction by basiliximab, combination of tacrolimus, mycophenolate mofetil and steroids.

Results: The procedure of 16 cases were successful, 15 of which stoped using insulin within 2 weeks postoperatively, fasting and postprandial blood glucose recovered to normal levels, and only 1 case still used insulin 24 U per day at the end of 1.5 months follow-up. Liver function recovered to normal at 1 week after transplantation., There were 2 cases died in the 1 to 69 months follow-up, 1 case died of graft versus host disease at one month after transplantation, and 1 case died of acute mononuclear leukemia at 12 months postoperatively. Other recipients were alive with normal allograft function. The longest survival time has been more than 5 years.

Conclusions: Modified upper abdominal organ cluster transplantation is a safe and feasible organ cluster transplant surgery, and can obviously improve life quality of the recipients postoperatively attributing to normal function of pancreas allograft, and is an efffective alternative method of classic abdominal organ cluster transplantation.

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