New surgical technique for pediatric en-bloc kidney and pancreas transplantation: the pancreas piggy-back

Novel surgical technique and efficacy analysis of donor pancreas preparation without vascular reconstruction in pancreas transplantation

Objective

Because of the complicated blood supply and vascular structure of the pancreas, blood vessel reconstruction and reshaping are generally required during pancreas transplantation. We modified the vascular preparation procedure for the donor pancreas (i.e., no vascular reconstruction was performed) based on experiences in our department and in other domestic and international transplantation centers.

Methods

Twelve donor pancreas preparations without vascular reconstruction were performed. The patch (Carrel patch), celiac trunk, and superior mesenteric artery were preserved as arterial inflow channels for the donor pancreas. The common hepatic artery and the gastroduodenal artery were transected at a site 0.5 cm away from the bifurcation. The bifurcated portion was preserved for the donor liver. The stumps of the gastroduodenal artery and common hepatic artery were then ligated. The portal vein was transected in the middle of the hepatoduodenal ligament during separation of the liver and pancreas. The partial portal vein preserved with the pancreas was used as the outflow channel of the donor pancreas.

Results

The transplanted pancreas functioned well in the recipients, and no vascular complications were reported.

Conclusion

The overall efficacy of pancreas transplantation without vascular reconstruction has been improved.

The Outcomes of Pancreatic Transplantation from Pediatric Donors-A Single Institution Experience

OBJECTIVES

The aim of this study was to compare the outcomes of pancreatic transplantation from pediatric donors younger than 15 years of age to the outcomes of pancreatic transplantation from adult donors.

METHODS

Sixty patients underwent pancreatic transplantation in our facility from August 2012 to June 2019. These patients were divided into two groups according to the age of the donor: Cases in which the donor was younger than 15 years of age were classified into the PD group (n = 7), while those in which the donor was older than 15 years of age were classified into the AD group (n = 53). The outcomes of pancreas transplantation were retrospectively compared between the two groups.

RESULTS

Pancreatic graft survival did not differ between the PD and AD groups. Furthermore, there were no differences in the HbA1c and serum creatinine levels at three months, with good values maintained in both groups. The results of oral glucose tolerance tests (OGTTs) revealed that the blood glucose concentration did not differ between the two groups. However, the serum insulin concentration at 30 min after 75 g glucose loading was significantly higher in the PD group.

CONCLUSION

The outcomes of pancreatic transplantation from pediatric donors may be comparable to those of pancreatic transplantation from adult donors and the insulin secretion ability after transplantation may be better.

Simultaneous en-bloc pancreas and kidney transplantation from a small pediatric donor after circulatory death

Simultaneous pancreas and kidney transplantation (SPKT) is an effective treatment option for patients with type 1 diabetes and end stage renal disease. Increasing demands for organs for transplantation coupled with a rise in age and size of adult donors has led to greater utilization of pediatric donors, and with good outcomes. Nonetheless, there remains reticence among transplant surgeons to transplant pancreases from small pediatric donors despite the optimal characteristics and macroscopic features of the younger pancreas. We report a successful case of SPKT from a small pediatric donor and explore the aspects of potential concern that might have led some clinicians to decline these organs. We also discuss the measures taken to overcome potential obstacles to successful transplantation from this donor source, and the rationale behind them.

Late-onset renal vein thrombosis: A case report and review of the literature

INTRODUCTION

Renal vein thrombosis, a rare complication of renal transplantation, often causes graft loss. Diagnosis includes ultrasound with Doppler, and it is often treated with anticoagulation or mechanical thrombectomy. Success is improved with early diagnosis and institution of treatment.

PRESENTATION OF CASE

We report here the case of a 29 year-old female with sudden development of very late-onset renal vein thrombosis after simultaneous kidney pancreas transplant. This resolved initially with thrombectomy, stenting and anticoagulation, but thrombosis recurred, necessitating operative intervention. Intraoperatively the renal vein was discovered to be compressed by a large ovarian cyst.

DISCUSSION

Compression of the renal vein by a lymphocele or hematoma is a known cause of thrombosis, but this is the first documented case of compression and thrombosis due to an ovarian cyst.

CONCLUSION

Early detection and treatment of renal vein thrombosis is paramount to restoring renal allograft function. Any woman of childbearing age may have thrombosis due to compression by an ovarian cyst, and screening for this possibility may improve long-term graft function in this population.

Retrieval of the pancreas allograft for whole-organ transplantation

Proper pancreas retrieval during multi-organ recovery is one of the cornerstones of technically successful whole-organ pancreas transplantation. With evolving surgical approaches for organ retrieval and implantation, it has become standard to procure the pancreas in conjunction with other abdominal organs without compromising either vasculature, graft quality, or transplant outcomes. This review summarizes the major steps required for proper whole-organ retrieval of the pancreas allograft with suggestions and tips whenever alternative approaches are available.