New surgical technique for pediatric en-bloc kidney and pancreas transplantation: the pancreas piggy-back

Abstract

Summary Combined pancreas and kidney transplantation is the therapy of choice for type I diabetes patients with associated end‐stage renal disease. To counterbalance increasing waiting lists, there is a clear need to extend the organ donor pool. Although results following simultaneous pancreas and kidney transplantation (SPK) using pediatric organs are encouraging, there is still reluctance in accepting them. This reflects the fear of graft thrombosis and graft failure because of small vessels and little absolute islet cell mass. Simpler transplant techniques for pediatric SPK might lower this threshold. In this article, a novel technique using a “piggy‐back” implantation of the pancreas onto the conduits of en‐bloc grafted kidneys, performed in two consecutive cases, is presented. This technique is associated with less vascular manipulation, requiring only one arterial anastomosis onto the frequently arteriosclerotic arteries of the recipient for all three organs. One‐year follow‐up (14 and 12 months) proved excellent graft function of kidneys and pancreas.

Simultaneous en-bloc pancreas and kidney transplantation from a small pediatric donor after circulatory death

“…Transplantation of kidneys from pediatric donors into adult recipients is a well‐established technique with successful outcomes, even from very small donors . In recent years, the technical feasibility of pancreas transplantation from pediatric donors has also been demonstrated . Yet, reports from small donors are few in number, and may reflect ongoing concerns within the pancreas transplant community regarding the use of such donors.…”

“…In some instances, dual kidneys have been transplanted along with the pancreas, meaning that only a single aortic conduit and caval outflow was required . Other techniques, such as the piggy‐back, anastomosed the reconstructed pancreas onto the aorto‐caval conduits which were, themselves, anastomosed to the recipient …”

“…Donor organ quality is directly related to transplantation outcomes; in pancreas transplantation, donor age and obesity are major determinants of successful transplantation . Increasing demands for organs for transplantation coupled with a rise in age and size of adult donors has led to greater utilization of pediatric donors, and with good outcomes . Nonetheless, there remains reticence amongst transplant surgeons to transplant pancreases from small pediatric donors despite the optimal characteristics and macroscopic features of the younger pancreas.…”

Retrieval of the pancreas allograft for whole‐organ transplantation

“…Dafoe and Ratner connected the renal artery and the vein to the splenic artery and the vein at the tail of the pancreas (72). Waldner et al, on the other hand, connected the pancreas graft to the distal end of the donor aorta and the IVC of en bloc kidneys (73). This concept has also been applied to revascularization of the pancreas and kidney graft in recipients with advanced atherosclerotic arterial disease (74,75).…”

Late-onset renal vein thrombosis: A case report and review of the literature

“…Simultaneous kidney pancreas transplant is the gold standard of treatment for Type I diabetic patients who have developed end-stage renal disease (ESRD) because it significantly increases survival 8, 9. Yet, graft thrombosis can occur after this procedure and may result in failure of both grafts, particularly if the thrombosis occurs in the pancreatic vessels 10 .…”