The delayed duct occlusion technique of human pancreatic transplantation

This is a report on a consecutive series of 50 primary human pancreatic transplants performed between 1980 and March 1989. All patients suffered from end-stage diabetic nephropathy, thus all received a kidney graft simultaneously. The basic technique consisted of intraperitoneal placement of a duct-occluded pancreas segment. The main technical and non-immunological complications included primary non-function (10%) because of ischemic damage or technical error, graft pancreatitis (4%), arterial thrombosis (6%) and venous thrombosis (16%). Five patients (10%) died in the later course with functioning transplant, and 10 transplants (20%) were lost due to acute or chronic rejection, 7 of them in the pre-cyclosporin era. The technical modifications introduced during these years to overcome complications consisted of temporary percutaneous drainage of the exocrine secretion for function control, delayed occlusion of the ductal system with polyurethane, and continuous heparin perfusion of the graft in the postoperative period by means of an arterial catheter.