Hemodynamic Analysis of Modified Splenic Arteriovenous Shunt in Pancreas Transplantation

This study aimed to evaluate the efficacy and safety of a modified splenic arteriovenous shunt technique in pancreas transplantation through intraoperative hemodynamic monitoring and postoperative follow-up.

A total of 12 patients undergoing simultaneous pancreas-kidney transplantation were enrolled. Under three consecutive intraoperative states (spleen preserved, splenic arteriovenous clamped, and splenic arteriovenous shunt created), color Doppler ultrasound was used to measure peak systolic velocity (PS) and volumetric flow (VF) of the splenic artery and vein at the same point in the distal pancreatic tail, while portal venous pressure was recorded using an intravascular pressure transducer. Postoperative graft function, thrombotic events, and complications were regularly followed up.

Compared with the spleen-preserved state, the clamped state showed significant reductions in splenic arterial PS and VF (15.24 ± 4.43 cm/s, 16.62 ± 6.84 mL/min) and splenic venous PS and VF (16.31 ± 3.82 cm/s, 60.32 ± 16.07 mL/min) (P < 0.001). In the shunt state, splenic arterial (54.47 ± 3.45 cm/s, 157.39 ± 11.24 mL/min) and venous (49.27 ± 6.61 cm/s, 177.89 ± 14.15 mL/min) flow parameters showed no significant differences compared with the spleen-preserved state (P > 0.05), but were significantly higher than those in the clamped state (P < 0.001). Portal venous pressure showed no significant differences among the three states (P > 0.05). At a median follow-up of 5 months, no graft thrombosis, pancreatitis, or gastrointestinal bleeding was observed, and patient and graft survival rates were both 100% at the last follow-up. Glycated hemoglobin decreased from 7.37% ± 0.68% preoperatively to 5.81% ± 0.32% (P < 0.005), and left ventricular ejection fraction increased from 59.50% ± 3.23% to 67.33% ± 2.84% (P < 0.005).

The modified splenic arteriovenous shunt maintains physiological perfusion of the pancreatic allograft without elevating portal venous pressure, and may mitigate the hypoperfusion and blood stasis associated with conventional splenic vessel ligation. Based on the short-term results of this study, this modified technique appears safe and feasible, and may contribute to reducing early thrombotic complications after pancreas transplantation.