Pancreas procurement technique. Lessons learned from an initial experience

Abstract

Background and aim of the study: Multiorgan procurement requires good anatomical knowledge and perfect synchronization between surgeons to ensure adequate dissection of visceral vessels. The aim of this article is to assess a technique for pancreas procurement in a multiorgan donor. Methods: starting our program of pancreas transplantation we adopted a technique for “in situ” simultaneous recovery of pancreas, liver and small bowel when indicated.We performed 3/4 of the dissection with an intact donor circulation of the organs so taht the cold ischemia time was kept to a minimum. The technique was used in 18 multiorgan cadaveric donors during a period of 74 months. Seventeen out of 18 pancreatic grafts were transplanted simultaneously with a kidney. The small intestine was transplanted in one case and the liver in 18 cases. Results: None of the transplanted pancreases sustained serious ischemic or vascular injuries. One pancreatic graft was discarded due to iatrogenic vascular injury during the procurement. Vascular surgical complications included 1 portal thrombosis, 1 iliac graft thrombosis and 1 iliac graft pseudoaneurysm. Pancreas allograft removal was necessary in 4 patients. All the retrived liver and the small intestine were successfully transplanted elsewhere. Conclusions: All except one of the pancreatic grafts retrived with this technique were of excellent quality. A perfect coordination between the different surgical equipes is mandatory in order to limit the risk of vascular injury, particulary in the presence of anatomical variations.