Pediatric En Bloc Dual Kidney-Pancreas Transplantation Into an Adult Recipient: a Simplified Technique. Benefits of the en bloc kidney-pancreas transplantation technique in pediatric donors

Abstract

The lower age limit for pancreas donors is not well defined. Fear of inadequate islet b -cell mass and of technical complications has hampered the use of pediatric donors. A surgical technique of 'en bloc' kidneypancreas is described.Both kidneys and pancreas were removed en bloc from a 13-kg, 31-month-old child. During bench preparation, one anastomosis was performed between the portal vein and the inferior vena cava. The proximal end of the aorta was closed. The bloc was transplanted into a 36-year-old type I diabetic patient intraperitoneally in the right iliac fossa.The kidneys functioned immediately. Pancreatic graft function resumed after POD 15 but insulin therapy was maintained until POD 112. Currently, the patient retains excellent kidney and pancreas graft functions.Very young donors can be accepted as pancreas donors for adult recipients, although slow recovery of pancreatic function can be expected. Use of the en bloc technique is well suited for very small children, as it prevents potential vascular complications.

Suitability of human juvenile pancreatic islets for clinical use

“…Similar findings were also reported by others [38]. More recent data indicate that the pancreas of a 31-month-old donor was able to establish glycaemia control in an adult recipient, providing superior insulin production ability to sustain a more challenging metabolic requirement [20]. In addition to physiological and metabolic aspects of the islet grafts, younger donors are the focus of studies aimed at identifying and exploiting islet cell precursors as a potential source for beta cell regeneration.…”

“…Beside the overall yield, no qualitative difference was noticed either in vitro or in vivo, according to age. Histopathological studies on diabetic patients, as well as evidence accrued from patients undergoing partial excision of the pancreas, suggest even a reduced islet mass maintains long-term glucose metabolism, and the outcome of paediatric pancreas transplantations also confirms that a juvenile pancreatic islet mass is sufficient to sustain the metabolic demands of adult, immunosuppressed, diabetic patients [20]. In our study, we showed that, from a morphological and in vitro functional point of view, young donor islets are similar to adult ones.…”

“…Previous studies in rodent models have established an inverse correlation between duration of islet graft function and donor age [19]. In clinical transplantation, pancreases obtained from young donors showed good performance in adult recipients [20], providing an additional rationale to justify the efforts to improve the isolation of islets from young donors and overcome the technical limitations in their complete purifica- tion. Very few reports have addressed the use of paediatric donors for islet isolation [15,16].…”

Retrieval of the pancreas allograft for whole‐organ transplantation

“…21) (67,(69)(70)(71). When the liver is not recovered, a common aortic patch including the celiac artery, SMA, and renal artery (or arteries) can be anastomosed to the recipient as a single arterial inflow.…”

Expanding the Pancreas Donor Pool

“…There is a continuing evolution in lower age and body size limits for pancreas donation; however, as a technique, a successful pediatric en bloc SPKT from a 13-kg, 31-month-old child donor has been reported [53].…”