Laurens J Ceulemans, Ewout Muylle, Gert De Hertogh, Andrea Zajacova, Marina G M C Mori da Cunha, Steffi De Pelsmaeker, Ina Benoy, Antoine Dubois, Thomas Douchy, Daphne Hompes, Albert Wolthuis, Diethard Monbaliu, Philippe Nafteux, Paul De Leyn, André D Hoore, Jacques Pirenne, Nele Van De Winkel
NVRF-alloTx is a versatile and effective reconstructive option for complex defects in SOT and non-SOT patients, providing an alternative to conventional meshes in challenging clinical scenarios.
OBJECTIVE: To report the expanding application of nonvascularized rectus fascia allotransplantation (NVRF-alloTx) in solid organ transplant (SOT) and non-SOT patients and evaluate its effectiveness, integration, and immunologic response in complex abdominal and thoracic reconstruction.
SUMMARY BACKGROUND DATA: Synthetic and biological meshes are limited by infection risk, long-term failure, donor-site morbidity, and high cost. NVRF-alloTx, first applied in intestinal/multivisceral-Tx with a 5.9% herniation rate, offers a simple and promising alternative for challenging defects.
METHODS: This prospective single-center study included all consecutive patients undergoing NVRF-alloTx (2020-2025). Patients were divided into 2 groups: (1) reconstruction in SOT patients (simultaneous or elective closure post-SOT) and (2) reconstruction in non-SOT patients, without immunosuppression. NVRF-allografts were procured from deceased donors, preserved at 2°C, and implanted without HLA-matching. Primary endpoints were successful closure, graft failure, and functional outcome. Clinical and radiologic follow-up was performed, with HLA donor-specific antibody (HLA-DSA) testing and histology whenever available.
RESULTS: Forty-seven NVRF-Tx procedures were performed in 41 patients using grafts from 48 deceased donors: group 1 (n=17) and group 2 (n=24). In 2 patients (4.9%), the graft did not integrate due to pancreatic leakage and vasopressor therapy. Others resulted in successful functional outcomes. Histology (n=5) showed graft integration through host fibrotic remodeling with neovascularization evident from 1 month after implantation. (De novo) HLA-DSA developed more frequently in non-SOT NVRF recipients than in SOT NVRF recipients.
CONCLUSIONS: NVRF-alloTx is a versatile and effective reconstructive option for complex defects in SOT and non-SOT patients, providing an alternative to conventional meshes in challenging clinical scenarios.