Technical factors that minimize the occurrence of early graft failure in pancreas transplantation

Abstract

Pancreatic transplantation is the only treatment for insulin-dependent diabetes resulting in long-term euglycemia without exogenous insulin. However, pancreatic transplantation has become debatable following the improvements in the results of islet transplantation and artificial pancreas. Therefore, surgeons who perform pancreas transplants require the best surgical technique that can minimize technical failure. We aimed to report our experiences with pancreatic transplantations.We transplanted 65 pancreatic grafts between 2015 and 2020. Except for one death due to hypoxic brain damage after surgery, no postoperative technical failure was observed. We usually perform duodeno-duodenal anastomosis using the transperitoneal approach, with retrocolic placement of the graft pancreas.There was no leakage from the duodenum even after immunologic graft failure. To prevent venous thrombosis, which is the most common cause of technical failure, we used the inferior vena cava for anastomosis and added graft venoplasty with a patch of donor vena cava or aortic interposition graft to the bench procedure; subsequently, there were no cases of technical failure due to thrombosis post-transplantation. Therefore, the 1-year graft survival (insulin-free) rate was more than 95%. The improving the surgical technique will maintain pancreatic transplantation as the best treatment for insulin-dependent diabetes. INTRODUCTIONAlthough pancreatic transplantation is the most effective beta-cell replacement therapy that can provide durable long-term euglycemia in patients with insulin-dependent diabetes, the number of transplantations has not increased in the United States or the rest of the World during last decade. [1][2][3] The number of transplantations has especially decreased in cases of isolated pancreas transplant, such as pancreas transplant after kidney (PAK) or pancreas transplant alone (PTA),

Modification of Venous Outflow to Avoid Thrombotic Graft Failure in Pancreas Transplantation

“…In a previous article, we discussed graft pancreas thrombosis and prevention [ 10 ]. In situations involving pancreatic transplantation, there is no blood flow from the spleen, small intestine, or colon.…”

“…The method of right and middle hepatic vein reconstruction is essential for the best outcome in living donor liver transplantation [ 9 ]. However, only a few studies of surgical modification to prevent graft thrombosis in pancreas transplantation have been conducted [ 10 – 14 ]. The reason for this relatively low level of attention to surgical technique could be the widely held belief that graft thrombosis occurs as a result of poor graft quality or the recipient’s medical condition, and thus surgical modification cannot be considered a solution for thrombosis.…”