A new technique for venous anastomosis of pancreatic allografts

Venous thrombosis is still a frequent cause of graft loss after pancreas transplantation where the portal vein is used for revascularisation. It is known that an increase in velocity of venous flow decreases the incidence of thrombosis. According to the equation of continuity, the flow velocity in the portal vein should decrease to 25% as compared with that in the splenic vein. Based on the rheological considerations we started to use the superior mesenteric vein, the diameter of which is similar to that of the splenic vein, for revascularisation of pancreas transplants after sewing the portal vein closed at its origin. This technique has been applied in 12 consecutive pancreatic transplants. Two patients died of a cerebrovascular accident and myocardial infarction, respectively. The only single pancreatic graft was lost due to rejection. The remaining 9 patients are alive and well between 2 and 23 months with normally functioning grafts. Another advantage of this technique is that a full-length portal vein can be left with the liver graft in the event of simultaneous liver and pancreas procurement.