Use of Nonvascularized Abdominal Rectus Fascia After Liver, Small Bowel, and Multiorgan Transplantation: Long-Term Follow-up of a Single-Center Series P.A. Farinelli, J.S. Rubio, J.M. Padín, C. Rumbo, H. Solar, D. Ramisch, and G.E. Gondolesi* Intestinal Failure, Rehabilitation and Transplant Unit, Hepatology, Hepato-Pancreato-Biliary Surgery and Liver Transplant Unit, Multiorgan Transplant Institute, Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina ABSTRACT Background. The abdominal wall may be severely compromised in the vast majority of intestinal and multiorgan transplant candidates, and sometimes as a consequence of complex liver transplantation. Multiple options have been described to overcome this problem, varying from component separation to the extreme need of performing an abdominal wall transplantation. The aim of the present paper is to report the largest and longest-term results of patients that received an abdominal rectus fascia (ARF) after liver, intestinal, or multiorgan transplantation at a single transplant center. Methods. This is a retrospective report of a prospectively collected dataset of all the patients that received ARF during liver, isolated intestine, combined, or multiorgan transplantation at Fundación Favaloro from May 2006 to June 2016. Results. A total of 19 out of 528 patients (3.5%) that underwent abdominal organ transplant received an ARF graft: 17 patients after receiving an intestine-containing graft, and 2 after liver retransplantations. Three patients required changing the ARF, 2 with a synthetic mesh and 1 with another ARF. Five patients required late reoperations: A relaparotomy was performed by transecting the ARF without encountering adhesions on the inner ARF surface. None of the 2 patients who received liver retransplantations and ARF developed acute or chronic ventral defects. Conclusions. The use of ARF is a simple and reliable surgical option to close abdominal wall defects during transplantation, the fascia adequately incorporates to the abdominal wall, allowing it to be transected and resutured in the long term and preserving the integrity of the peritoneal layer. T HE ABDOMINAL wall can be severely compromised in the vast majority of intestinal and multiorgan transplant candidates owing to fistulas, acquired or congenital wall defects, and multiple surgeries. Sometimes in liver transplant recipients with multiple previous operations or complex postoperative course requiring multiple operations, closing the abdomen might be problematic as well. The severity of abdominal wall defects is increased when patients have current or prior ostomies or fistulas, or when the abdomen has been managed open owing to severe previous complica- tions in patients requiring a retransplantation [1,2]. The problems described might result in severe scarring and fibrosis of the anterior and lateral aspects of the abdominal wall, with additional effect caused by different degrees of intestinal resections, causing loss of the abdom- inal content, further retraction of the abdominal wall, and severe loss of the abdominal domain [3]. This condition is *Address correspondence to Prof Gabriel E. Gondolesi, MD, Jefe de Cirugía General y de las Unidades de Insuficiencia, Rehabil- itación y Trasplante Intestinal, Hepatología, Cirugía HPB y Trasplante Hepático y Trasplante Reno-pancreático, Investigador del Instituto de Medicina Translacional, Inmunología y Bioenginiería, Universidad Favalor-Conicet, Hospital UniversitarioeFundación Favaloro, Av Belgrano 1782, CABA (1093), Buenos Aires, Argentina. E-mail: ggondolesi@ffavaloro.org 0041-1345/17 http://dx.doi.org/10.1016/j.transproceed.2017.05.012 ª 2017 Published by Elsevier Inc. 230 Park Avenue, New York, NY 10169 1810 Transplantation Proceedings, 49, 1810e1814 (2017)