Surgical injuries of pancreatic allografts during procurement

Abstract

Quality of most procured pancreata is considered acceptable or good by surgeons, but remains difficult to ascertain. Little is known on how often pancreata are refused for transplantation during back-table inspection. Purpose of this study was to determine the frequency and type of problems responsible for refusal during back-table inspection and to identify possible risk factors. All 134 pancreata accepted and procured for whole-organ transplantation and transported to the Leiden University Medical Center in the period February 2002 until May 2008 were included. These were retrospectively analyzed on donor characteristics, procurement characteristics, and (non-)critical problems. A total of 111 (82.8%) pancreata were transplanted while 23 (17.2%) were refused for transplantation during back-table inspection, regardless of procurement region (χ(2) = 0.16 p = 0.93). Fourteen pancreata (13.4%) were refused solely because of surgical injuries. In refused pancreata, on average 2.7 critical problems per pancreas were found and 0.6 non-critical problems (vs. 0.3 in transplanted pancreata, t = 1.83 p = 0.08). Chances of refusal increased in pancreata from older donors (odds ratio 1.08 [1.02-1.14]) procured in centers not performing pancreas transplantations (odds ratio 7.95 [2.43-25.97]). We conclude that pancreatic allografts are frequently refused during back-table inspection, partly because of the surgical injuries suggesting that quality of procurement may be improved.

Professionalization of surgical abdominal organ recovery leading to an increase in pancreatic allografts accepted for transplantation in the Netherlands: a serial analysis

“…The same argument goes for kidney transplantation where poor perfusion and poor biopsy results may lead to a withdrawal as shown in a recent report from the OPTN . The refusal based on surgical injury is much higher for pancreas recovery, where the incidence ranges from 16.6% to 52% with loss of transplantation in 12% up to 17.2% after the initial acceptance as described in earlier studies . The margin of error is therefore much narrower when it comes down to pancreas recovery.…”

“…However, subjective selection bias because of trust issues towards the recovering surgeon can not entirely be ruled out. This is also shown to be the case in other reports . Nevertheless, we tried to limit this by including recovering surgeons from other pancreas transplant centres in our analysis.…”

Impact of adverse pancreatic injury at surgical procurement upon islet isolation outcome

“…The present work is the first report of the rate of surgical injuries to the pancreata procured for islet isolation purposes. Although the injuries of the main vessels are a frequent reason to decline the organ in the case of whole pancreas transplantation , injuries of the parenchyma may negatively affect the outcome of islet transplantation by reducing the yield of islet isolation procedures. The cause of decreased islet yield related to a major injury was not directly assessed in this study.…”

Pancreas transplantation in the treatment of diabetes mellitus type 1: modern aspects

“…Первая стратегия дает возможность сократить время про-цедуры изъятия органов, вторая -лучше оценить возможные анатомические вариации. Однако нет доказательств преимущества одной техники над другой [43]. Изъятие поджелудочной железы обыч-но является частью стандартной процедуры муль-тиорганной эксплантации.…”

“…По данным Британского регистра, риск поврежде-ния поджелудочной железы в момент экспланта-ции значительно повышается у доноров с высоким индексом массы тела, при наличии аберрантной печеночной артерии, при выполнении совместной эксплантации печени, в особенности если хирур-ги, выполняющие изъятие печени, не имеют опыта трансплантации поджелудочной железы [44]. Около 1/3 отклоненных поджелудочных желез имеют при-знаки выраженного атеросклероза сосудов [43].…”