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Mesothelioma is an aggressive and rare tumor with limited therapeutic options. Delayed presentation and subacute or chronic disease compromise standard therapies, creating a complex challenge for management. Limited reports have documented improved outcomes for multivisceral transplantation in mesothelioma. Herein, the authors describe the Cleveland Clinic experience with multivisceral transplantation in mesothelioma. This is a retrospective case review of the Cleveland Clinic’s multivisceral transplant program from 1995 to 2016 with patients diagnosed with mesothelioma. Perioperative information and survival data were analyzed. Twenty patients underwent 18 operations. The series included 21 multivisceral transplants with 16 liver-versus-liver, three liver-versus-pancreas, and two pancreas-versus-kidney transplants. Median age was 57 years (range, 23-69 y), and median delay to transplant was 14 months (range, 3-180 mo). The mean number of organs per transplant was 3.9 (range, 2-5), and the mean amount of ascites was 1.6 L (range, 0-13 L). The cumulative 1-year and 3-year graft survival for liver-versus-liver transplants was 86.5% and 69.2%, respectively, for all transplants and 83.3% and 63.3%, respectively, in the subacute or chronic mesothelioma group. In this series, multivisceral transplantation can be considered for a subgroup of subacute or chronic mesothelioma patients with large amounts of ascites.A Game of Thrones is one of the greatest adaptations in television history, but who would have guessed that it would be as big as it is today?
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