Joana Ferrer1, Víctor Molina2, Ramón Rull2, Miguel Ángel López-Boado2, Santiago Sánchez2, Rocío García2, Ma José Ricart3, Pedro Ventura-Aguiar3, Ángeles García-Criado4, Enric Esmatjes5, Josep Fuster2, Juan Carlos Garcia-Valdecasas2. 1. Cirugía Hepatobiliopancreática y Trasplante Hepático y Pancreático, Instituto de Enfermedades Metabólicas y Digestivas, Hospital Clínic, Universidad de Barcelona, Barcelona, España. Electronic address: joferrer@clinic.cat. 2. Cirugía Hepatobiliopancreática y Trasplante Hepático y Pancreático, Instituto de Enfermedades Metabólicas y Digestivas, Hospital Clínic, Universidad de Barcelona, Barcelona, España. 3. Unidad de Trasplante Renal, Servicio de Nefrología y Trasplante Renal, Hospital Clínic, Barcelona, España. 4. Servicio de Radiología, Centro de Diagnóstico por la Imagen, Hospital Clínic, Barcelona, España. 5. Unidad de Diabetes, Servicio de Endocrinología y Nutrición, Instituto de Enfermedades Metabólicas y Digestivas, Hospital Clínic, Barcelona, España.
Abstract
INTRODUCTION: In the 50 years since the first pancreas transplant performed at the University of Minnesota, the surgical techniques employed have undergone many modifications. Techniques such as retroperitoneal graft placement have further improved the ability to reproduce the physiology of the «native» pancreas. We herein present our experience of a modified technique for pancreatic transplant, with the organ placed into a fully retroperitoneal position with systemic venous and enteric drainage of the graft by duodeno-duodenostomy. METHODS: All pancreas transplantations performed between May 2016 and January 2017 were prospectively entered into our transplant database and retrospectively analyzed. RESULTS: A total of 10 transplants were performed using the retroperitoneal technique (6 men: median age of 41 years [IQR 36-54]). Median cold ischemia times was 10,30h [IQR 5,30-12,10]. The preservation solution used was Celsior (n=7), IGL-1 (n=2), and UW (n=1). No complications related to the new surgical technique were identified. In one patient, transplantectomy at 12h was performed due to graft thrombosis, probably related to ischemic conditions from a donor with prolonged cardio-respiratory arrest. Another procedure was aborted without completing the graft implant due to an intraoperative immediate arterial thrombosis in a patient with severe iliac atheromatosis. No primary pancreas non-function occurred in the remaining 8patients. The median hospital stay was 13,50 days [IQR 10-27]. CONCLUSIONS: Retroperitoneal graft placement appears feasible with easy access for dissection the vascular site; comfortable technical vascular reconstruction; and a decreased risk of intestinal obstruction by separation of the small bowel from the pancreas graft.
INTRODUCTION: In the 50 years since the first pancreas transplant performed at the University of Minnesota, the surgical techniques employed have undergone many modifications. Techniques such as retroperitoneal graft placement have further improved the ability to reproduce the physiology of the «native» pancreas. We herein present our experience of a modified technique for pancreatic transplant, with the organ placed into a fully retroperitoneal position with systemic venous and enteric drainage of the graft by duodeno-duodenostomy. METHODS: All pancreas transplantations performed between May 2016 and January 2017 were prospectively entered into our transplant database and retrospectively analyzed. RESULTS: A total of 10 transplants were performed using the retroperitoneal technique (6 men: median age of 41 years [IQR 36-54]). Median cold ischemia times was 10,30h [IQR 5,30-12,10]. The preservation solution used was Celsior (n=7), IGL-1 (n=2), and UW (n=1). No complications related to the new surgical technique were identified. In one patient, transplantectomy at 12h was performed due to graft thrombosis, probably related to ischemic conditions from a donor with prolonged cardio-respiratory arrest. Another procedure was aborted without completing the graft implant due to an intraoperative immediate arterial thrombosis in a patient with severe iliac atheromatosis. No primary pancreas non-function occurred in the remaining 8patients. The median hospital stay was 13,50 days [IQR 10-27]. CONCLUSIONS: Retroperitoneal graft placement appears feasible with easy access for dissection the vascular site; comfortable technical vascular reconstruction; and a decreased risk of intestinal obstruction by separation of the small bowel from the pancreas graft.
Authors: Joana Ferrer-Fàbrega; Emma Folch-Puy; Juan José Lozano; Pedro Ventura-Aguiar; Gabriel Cárdenas; David Paredes; Ángeles García-Criado; Josep Antoni Bombí; Rocío García-Pérez; Miguel Ángel López-Boado; Ramón Rull; Enric Esmatjes; Maria José Ricart; Fritz Diekmann; Constantino Fondevila; Laureano Fernández-Cruz; Josep Fuster; Juan Carlos García-Valdecasas Journal: Transpl Int Date: 2022-03-28 Impact factor: 3.782
Authors: Enrique Montagud-Marrahi; Alicia Molina-Andújar; Adriana Pané; Maria José Ramírez-Bajo; Antonio Amor; Enric Esmatjes; Joana Ferrer; Mireia Musquera; Fritz Diekmann; Pedro Ventura-Aguiar Journal: BMJ Open Diabetes Res Care Date: 2020-03