{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,26]],"date-time":"2026-04-26T17:35:52Z","timestamp":1777224952483,"version":"3.51.4"},"reference-count":17,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T00:00:00Z","timestamp":1775174400000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Achieving a tension\u2010free abdominal wall closure in liver transplantation (LT) is challenging, particularly in the presence of donor\u2013recipient size mismatch, prior surgeries, or loss of abdominal domain. These difficulties are amplified when expanded\u2010criteria donor (ECD) grafts are used, as graft reduction is unsafe and prolonging cold ischemia time (CIT) is not feasible. A vascularized posterior rectus sheath (PRS) allograft, supplied via the hepatic falciform artery (HFA), offers physiological abdominal domain expansion without the infection risks associated with prosthetic meshes or non\u2010vascularized fascia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective review was conducted of all patients undergoing LT with a vascularized PRS allograft at our center. PRS retrieval and implantation were performed using a standardized technique. All patients received conventional immunosuppression. Recipient and donor characteristics, postoperative outcomes, and long\u2010term follow\u2010up were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Five patients (four adults, one child) received a composite liver\u2013PRS allograft. Median donor\u2013recipient weight ratio was 1.7 (range: 1.46\u20132.18). All grafts met ECD criteria. Mean CIT and warm ischemia time were 4 \u00b1 1.01 h and 43.6 \u00b1 9.54 min, respectively. Primary fascial closure was achieved in all patients without graft infection, abdominal wall infection, or PRS necrosis. One patient developed a rectus sheath hematoma requiring drainage, and another developed a postoperative bulge requiring plication. Median long\u2010term follow\u2010up of 9.1 (range: 8.38\u201310.63) years demonstrated durable fascial integrity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The vascularized PRS allograft is a simple, reproducible, single\u2010stage solution for abdominal closure in LT, particularly valuable when using ECD grafts, minimizing infection risk, reexplorations, and prolonged CIT.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ctr.70525","type":"journal-article","created":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T11:45:22Z","timestamp":1775216722000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Expanding the Abdominal Domain: Long\u2010Term Success of the Vascularized Posterior Rectus Sheath\u2013Liver Composite Allograft"],"prefix":"10.1111","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0157-1537","authenticated-orcid":false,"given":"Anurag","family":"Shrimal","sequence":"first","affiliation":[{"name":"HPB Surgery and Liver Transplant Gleneagles Hospital  Mumbai India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1736-6693","authenticated-orcid":false,"given":"Arka","family":"Banerjee","sequence":"additional","affiliation":[{"name":"HPB Surgery and Liver Transplant Gleneagles Hospital  Mumbai India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1067-1708","authenticated-orcid":false,"given":"Vaishnavi","family":"Chakravarthy","sequence":"additional","affiliation":[{"name":"Department of Urology, Ulster Hospital South Eastern Health and Social Care Trust  Northern Ireland UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7275-3771","authenticated-orcid":false,"given":"Rohan J","family":"Choudhary","sequence":"additional","affiliation":[{"name":"HPB Surgery and Liver Transplant Gleneagles Hospital  Mumbai India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8723-9994","authenticated-orcid":false,"given":"Amit","family":"Chopde","sequence":"additional","affiliation":[{"name":"HPB Surgery and Liver Transplant Gleneagles Hospital  Mumbai India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3006-1683","authenticated-orcid":false,"given":"Aditya","family":"Kunte","sequence":"additional","affiliation":[{"name":"HPB Surgery and Liver Transplant Gleneagles Hospital  Mumbai India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1374-2734","authenticated-orcid":false,"given":"Manish C","family":"Varma","sequence":"additional","affiliation":[{"name":"Department of Abdominal Transplantation and Liver Surgery Tufts Medical Centre  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,4,3]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.12659\/AOT.934595"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cireng.2019.05.001"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s002610000207"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600\u20106143.2010.03331.x"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.trre.2021.100634"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3182789c28"},{"issue":"3","key":"e_1_2_11_8_1","first-page":"270","article-title":"A New Technique of Side to Side Caval Anastomosis During Orthotopic Hepatic Transplantation Without Inferior Vena Caval Occlusion","volume":"175","author":"Belghiti J.","year":"1992","journal-title":"Surgery, Gynecology & 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\u201d ATC Abstracts Accessed November 15 2025 https:\/\/atcmeetingabstracts.com\/abstract\/use\u2010of\u2010en\u2010bloc\u2010vascularized\u2010rectus\u2010sheath\u2010allograft\u2010to\u2010achieve\u2010abdominal\u2010closure\u2010in\u2010pediatric\u2010liver\u2010and\u2010multivisceral\u2010transplantation\/."},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2008.06.105"}],"container-title":["Clinical 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