67: Long-term outcome after non-vascularized rectus fascia transplantation in solid organ transplantation: A global multi-center IRTA survey.

Introduction: Closure of the abdominal wall after solid organ transplantation (SOT) is of utmost importance since an open abdomen following SOT increases morbidity and mortality. Closure remains challenging and can, amongst other, be achieved by non-vascularized rectus fascia (NVRF) transplantation. Several reports have confirmed excellent short-term outcome. However, long-term outcome remains unknown. With this multicenter survey we aim to analyze the worldwide experience and long-term clinical outcome after NVRF transplantation. Methods: This study was approved by the International Rehabilitation and Transplantation Association (IRTA) scientific committee. All IRTA members were invited to participate to this anonymized survey via mail with 3 reminders and webpage announcement between September 22nd, 2021 and June 28th, 2022. The survey was excel based and included all NVRF after SOT, isolated intestinal (ITx), Liver (LTx), combined liver-intestine (cLITx), and multivisceral transplantation (MVTx). The survey was classified into a pre-, intra-, and postoperative questionnaire. Data analysis was performed after closure of the survey. Results: Twenty-nine centers responded of which 8 transplant centers included a total of 98 patients. From the 98 patients (25 children, 72 adults, 1 not mentioned), 28 underwent ITx (28.57%), 26 MVTx (26.53%), 20 cLITx (20.41%), and 24 other SOT (24.49%). The NVRF was sewed in as an inlay in 85 patients (86.73%). 30 NVRF (30.61%) were third party (NVRF different from the solid organ donor). In 30 patients (30.61%), surgical site infections (SSI) occurred. Seventy-one patients (72.44%) had reoperations, of them 18 patients (25.35%) had NVRF removal. At a median follow up of 31 months (10-63.5) 17 patients presented with bulging of the abdominal wall (17.35%), 5 with a clinical hernia (5.10%), and 2 with a radiographic diagnosis of a hernia (2.04%). Conclusion: With this survey, we collected 98 NVRF transplants from 8 transplant centers worldwide. Despite the major surgical interventions in high-risk patients under profound immunosuppression an excellent long-term outcome was observed.