Modified multivisceral transplantation without a liver graft for Gardner/Desmoid syndrome and chronic intestinal pseudo-obstruction

Multivisceral transplant (MVTx) was first performed by Starzi et al in 1988.[1] The results of small bowel transplantation have improved in the past 5 years secondary to the development of new immunosuppressive regimens, to refinements of surgical techniques, as well as to a better candidate selection. [2] The indications for small bowel transplantation are intestinal failure due to congenital or acquired anatomical loss of the intestine, vascular disease, primary disorders of intestinal motility, such as chronic idiopathic pseudo-obstruction syndrome (CIPOS), and intestinal mucosal disease leading to malabsorption. To these typical indications we can add Gardner’s syndrome (familial multiple polyposis) and desmoid tumors. [3] Gardner’s syndrome can affect the whole gastrointestinal tract, often presenting with desmoid lesions at the root of the mesentery. In some patients isolated small bowel transplantation is not crucial to completely treat the disease. Gastric and esophageal manometry is often used to assess whether the patient needs an isolated small bowel transplant or a MVTx. Here we report two cases of modified MVTx without the liver for Gardner/Desmoid syndrome and for CIPOS.