Orthotopic placement of a segmental pancreas graft for transplant: a case report

Abstract

Pancreas retransplantation has become more frequent and represents a technical challenge for surgeons. Knowledge of alternative surgical options could be useful in difficult cases. We present a case of brutal diabetes mellitus in a patient with severe vascular disease that underwent a third pancreas transplant. Difficulties in obtaining arterial inflow were solved utilizing the native splenic vessels, placing the graft in orthotopic position, and a combination of historical surgical techniques in pancreas transplantation; that is, segmental grafts and duct injection for exocrine management made transplantation successful.

How to do a spleen preserving porto‐splenic pancreas transplantation

“…The use of the native splenic vessels to revascularize segmental pancreatic grafts has been described by Calne with exocrine drainage into the stomach and by Garcia‐Roca et al 8,9 . The use of segmental grafts is technically more demanding as compared to a whole pancreas graft.…”

“…The use of the native splenic vessels to revascularize segmental pancreatic grafts has been described by Calne with exocrine drainage into the stomach and by Garcia-Roca et al 8,9 The use of segmental grafts is technically more demanding as compared to a whole pancreas graft. Using the splenic vein and artery for whole organ implantation with concurrent spleen preservation has not been previously described.…”

Repeat Pancreas Transplant Procedures: Recipient Selection and Surgical Techniques

“…She had severe atherosclerosis (pipestem) pelvic vasculature. The second PAK was a segmental pancreas transplant placed orthotopically (using the splenic artery and vein) [26]. This graft had been duct injected and failed after 2.5 years.…”