Long-term Outcome After Nonvascularized Rectus Fascia Transplantation in Solid Organ Transplantation: A Global Multicenter IIRTA Survey.

Background: Abdominal wall (AW) closure after solid organ transplantation (SOT) is challenging in case of loss of abdominal domain and/or large-for-size grafts. Primary closure is crucial to avoid open abdomen-associated morbidity and mortality. Several techniques have been developed to address this challenge, including nonvascularized rectus fascia transplantation (NVRF Tx). Long-term outcome is missing. Methods: We designed a multicenter survey to analyze the worldwide experience after NVRF Tx. International Intestinal Rehabilitation And Transplantation Association members were invited to participate to a questionnaire. The survey included all NVRF Tx performed after SOT. Questions were classified into pre-, intra-, and postoperative data. Results: Of the 29 responding centers, 8 performed NVRF Tx, comprising 98 patients in total. Thirty-two patients underwent multivisceral Tx (33.3%), 27 isolated intestinal Tx (28.1%), 21 combined liver-intestinal Tx (21.9%), 8 liver Tx (8.3%), 8 other SOT (8.3%), and 2 (2.0%) not reported. Thirty NVRF (30.9%) were from third-party donors. Thirty patients (31.3%) had surgical site infections. Seventy-one (74.0%) patients had reoperations, of them 18 (26.1%) patients had NVRF removal. Median follow-up time was 31 mo (10.0-63.5). Seventeen patients presented with bulging of the AW (18.7%), 5 with herniation (5.9%). No NVRF graft rejection was reported. Conclusions: This survey reports long-term outcome after NVRF Tx, with herniation in a limited number of patients, no suspicion of clinical rejection and no additional infection and mortality. NVRF Tx has proven to be a useful option, belonging to the standard armamentarium for AW closure after SOT.