This innovation from Leuven thus marks a double world first: for the first time, doctors are performing abdominal wall transplants without immunosuppressive medication, and for the first time, they are using donor tissue from the abdomen for complex reconstructive procedures in the chest. The results have been published in the renowned scientific journals Annals of Surgery and The Journal of Thoracic and Cardiovascular Surgery.
For large, gaping wounds in, for example, the abdominal wall, chest wall, or diaphragm, surgeons traditionally use synthetic meshes to restore structural integrity. However, in patients with an infection, these synthetic materials can cause serious problems, requiring their removal. Biological tissues of animal origin are an alternative, but they are expensive and do not always provide sufficient structural integrity.
Surgeons in Leuven therefore began using the rectus fascia—the strong abdominal wall tissue surrounding the rectus abdominis muscles of a deceased donor. This “six-pack” of the abdominal wall is strong, flexible, and biological. In traditional organ transplants, such as lung, kidney, or liver transplants, patients must take medication for the rest of their lives to prevent rejection. With this new publication, UZ Leuven demonstrates that such medication is not necessary for this type of tissue transplant. Such biological reinforcement offers significant added value, particularly for patients with an infection or a highly complex wound. Doctors at UZ Leuven have now performed more than 80 of these types of abdominal wall transplants.
This discovery suddenly opens up a whole range of new possibilities in medicine
prof. dr. Laurens Ceulemans
After the transplant, the tissue integrates into the recipient’s body and receives blood supply from the patient’s surrounding tissue. The hospital can store the donor abdominal wall tissue for one month, making it available when a patient needs complex reconstruction. A matching blood type is also not required, which makes the technique much simpler and more widely applicable.
Also for tissue repair in the chest
Professor Ceulemans performed Belgium’s first abdominal wall transplant as early as 2020: two intestinal transplant patients received a new abdominal wall made from tissue from a deceased donor. At that time, the patients were still receiving immunosuppressive medication. Now, the surgical team at UZ Leuven has demonstrated that an abdominal wall graft can also be used to reconstruct the diaphragm, the pericardium, and the chest wall—all without the need for immunosuppressive medication. This expands the scope of a transplant technique originally developed for the abdominal wall to a much broader range of applications. The donor tissue acts as a strong biological repair material that surgeons can tailor for use in other parts of the body where sturdy, flexible, and infection-resistant tissue is needed. The technique has also been successfully applied in cases of severe damage to the pelvis or other areas that are difficult to reconstruct.
Prof. dr. Laurens Ceulemans, thoracic and transplant surgeon at UZ Leuven and coordinator of abdominal wall transplants at UZ Leuven: “With abdominal wall tissue, we can now help patients for whom traditional reinforcement techniques do not offer a good solution. Abdominal wall transplantation is a relatively simple technique that has broad applications across a wide range of surgical disciplines. The discovery that we can use this tissue not only to repair abdominal walls but also to treat defects in virtually any part of the body suddenly opens up a whole new range of possibilities in medicine. It is an innovation that arose from close collaboration between surgeons from different specialties. “Our combined knowledge has led to a solution that will be able to help many patients with a wide range of physical injuries.”
New possibilities for pelvic floor surgery
Researchers in Leuven now want to study the technique for other conditions that require strong biological support tissue. An important future application is the repair of congenital diaphragmatic defects in children. In cases of large congenital diaphragmatic hernias, it is sometimes impossible to close the diaphragm. Donor abdominal wall tissue could also serve as a biological alternative to synthetic material for these patients in the future. In addition, doctors are considering applications in pelvic floor surgery, such as in cases of severe bladder prolapse: here, too, strong supportive tissue is needed to restore the anatomy of the bladder. Professor Ceulemans’ team is currently investigating these applications in the lab and in the hospital.
International partnerships
Prof. dr. Laurens Ceulemans recently presented the results at the European Surgical Association (ESA) congress in Rome, where he received first prize for his research. With more than 80 patients treated, the use of donor abdominal wall tissue has evolved from an experimental transplant concept into a new form of biological tissue repair with applications across various surgical disciplines. Through workshops and international collaborations, the Leuven surgeons aim to transfer the technique to other hospitals and research centres. UCLouvain has also since successfully applied the technique to a patient. In Belgium, legislation stipulates that everyone is an organ and tissue donor, unless they have indicated otherwise during their lifetime.
The research and transplants were carried out in collaboration with the departments of thoracic surgery, abdominal transplantation, abdominal surgery, surgical oncology, urology, plastic surgery and gynaecology. For this innovation, Professor Ceulemans collaborated with dr. Nele Van De Winkel, dr. Marina Da Cunha, dr. Ewout Muylle, prof. dr. Diethard Monbaliu, prof. dr. Jacques Pirenne, prof. dr. André D’Hoore, prof. dr. Daphne Hompes, dr. Thomas Douchy, prof. dr. Lieven Depypere, prof. dr. Philippe Nafteux, prof. dr. Paul De Leyn, as well as with the organ retrieval surgeons and transplant coordinators led by Karen Denaux. The possibility of using abdominal wall tissue for transplantation without the need for immunosuppressive medication was first demonstrated in the laboratory during the PhD research of dr. Nele Van De Winkel, an abdominal wall surgeon at UZ Leuven. For the latest applications in the laboratory and the hospital, prof. dr. Ceulemans is collaborating with prof. dr .Jan Deprest and prof. dr. Ann-Sophie Page, as well as with the KULAK laboratory led by prof. Lieven Thorrez.
Transplants at UZ Leuven
In the autumn of 2026, UZ Leuven will become the first hospital in Belgium to reach the historic milestone of 10,000 transplants. This figure represents the total number of organ transplants carried out at the hospital since the transplant programme began in 1963.