Pancreas Transplant with Duodeno-Duodenostomy and Caval Drainage Using a Diamond Patch Graft: A Single-Center Experience
Je Ho Ryu, Tae Beom Lee, Young Mok Park, Kwang Ho Yang, Chong Woo Chu, Jung Hee Lee, Taeun Kim, Byung Hyun Choi
Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea
Ann Transplant 2017; 22:24-34
Available online: 2017-01-19
The surgical technique used in pancreas transplant is essential for patient safety and graft survival, and problems exist with conventional strategies. When enteric exocrine drainage is performed, there is no method of immunologic monitoring other than direct graft pancreas biopsy. The most common cause of early graft failure is graft thrombosis, and adequate preventive and treatment strategies are unclear. To overcome these disadvantages, we suggest a modified surgical technique.
MATERIAL AND METHODS: Eleven patients underwent pancreas transplant with our modified technique. The modified surgical techniques are as follows: 1) graft duodenum was anastomosed with recipient duodenum to enable endoscopic immunological monitoring, and 2) the inferior vena cava was chosen for vascular anastomosis and a diamond-shaped patch was applied to prevent graft thrombosis.
RESULTS: No patient mortality or graft failure occurred. One case of partial thrombosis of the graft portal vein occurred, which did not affect graft condition, and resolved after heparin treatment. All patients were cured from diabetes mellitus. There were no cases of pancreatic rejection, but 2 cases of graft duodenal rejection occurred, which were adequately treated with steroid therapy.
CONCLUSIONS: This modified surgical technique for pancreas transplant represents a feasible method for preventing thrombosis and allows for direct graft monitoring through endoscopy.
Keywords: Duodenoscopes, Pancreas Transplantation, Ultrasonography, Doppler, Color, Vena Cava, Inferior