Combined whole pancreas and liver retrieval: comparison between Y-iliac graft and splenomesenteric anastomosis

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Abstract. With the recent increase in the number of liver and pancreas transplants being performed in Europe, many groups have found it necessary to develop techniques for the combined harvesting of whole pancreaticoduodenal and liver grafts. To date we have carried out a total of 35 multiorgan procurements including liver, heart, pancreas, and kidneys. In ten cases we reconstructed the arterial supply of the pancreas with an end-to-end anastomosis between the proximal splenic artery and the distal end of the superior mesenteric artery (SMA), and in eight patients we used a donor Y-iliac graft. Patients were monitored postoperatively by determination of BUN, serum creatinine, blood glucose, serum and urinary amylase levels, and Doppler assessment of the graft was carried out at regular intervals. Mean ischemia/preservation time in both groups was 6 h. All simultaneous kidney and pancreas transplants functioned well initially with none of the patients requiring dialysis. All patients were insulin-free immediately after surgery. One patient in the splenomesenteric group developed venous thrombosis of the graft, requiring removal of the gland, but has subsequently been successfully retransplanted. All remaining patients have been insulin-free for 1–14 months. One patient in the Y-iliac group also developed venous thrombosis of the graft, but all remaining patients in this group have been insulin-free for 1–12 months after transplantation. Both groups were comparable in terms of serum creatinine (1.4 ±1.0 vs 1.5±0.9mg%), blood glucose (105 ±15 vs 104±12 mg%), serum amylase (400 ± 106 vs 410 ± 100 IU/l). and urinary amylase (130,000 ±54,000 vs 100,000 ± 42.000 IU/l). Therefore, we now prefer to use this simpler technique of splenomesenteric revascularization as a first choice for reconstruction of pancreatic grafts.

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