Outcomes of Pancreas Allografts Procured Simultaneously With an Isolated Intestine Allograft

Abstract

These results suggest that pancreas allografts procured simultaneously with an isolated intestine graft, although technically more challenging, do not have significantly inferior survival outcomes.

Retrieval of the pancreas allograft for whole‐organ transplantation

“…The more distal SMA and SMV, including the most proximal jejunal branches, are preserved with the intestinal graft (3,4). One way of achieving this is to perform a total abdominal colectomy at the time of procurement and follow the middle colic artery proximally to its origin from the SMA, which usually represents the ideal site for transection of the SMA.…”

“…The "default" for deceased donors meeting these criteria is that, in the absence of a donor history of diabetes, the pancreas should be recovered for transplantation in virtually all cases. These donors are also likely to be suitable for either whole-organ or split liver recovery and intestinal recovery, but it should usually be possible to procure and transplant all of these combinations of abdominal organs from the same donor provided that the abdominal organ recovery is performed by an experienced team (3,4). It is extremely unfortunate when a pancreas graft that is otherwise appropriate for transplantation is not recovered either because of avoidable surgical damage, atypical anatomy, or the lack of availability of an experienced pancreas recovery surgeon.…”

Expanding the Pancreas Donor Pool

“…The reality is that in most circumstances both the intestine and the pancreas can be safely procured and transplanted from a single donor, but it is strongly recommended that an experienced pancreas recovery surgeon participate in the retrieval operation [58,63,64].…”

“…The mesentery of the small bowel must be divided in situations where a multi-organ donor will be donating a pancreas and a solitary intestinal allograft, thus preserving the proximal SMA and SMV with their pancreatic branches to the head of the pancreas as well as to the duodenum, with the pancreas allograft and the more distal SMA and SMV along with the most proximal jejunal branches, with the intestinal graft [63,64]. A useful way to achieve this desired outcome, at the time of procurement, is to perform a total abdominal colectomy and to follow the middle colic artery proximally to its origin from the SMA.…”

Feasibility of safe procurement of isolated intestinal and pancreatic grafts

“…This probably arises from lack of communication between the procurement and implanting teams. There is limited number of publications in the literature on isolated small bowel procurement, preserving the pancreas also as an isolated graft [8,10]. UNOS data suggest from 159 adult donors, isolated pancreata have been transplanted that were procured from a same donor of an isolated small bowel graft.…”