Segmental pancreas transplantation in the canine model. A reappraisal

Segmental vascularized grafts of pancreatic tissue have been recommended in the treatment of juvenile onset insulin-dependent diabetes mellitus. The method of intraperitoneal placement and unligated pancreatic duct provided a low incidence of exocrine complications, but clinical results were less than ideal. To further assess this technique, we used segmental pancreatic autografts in the canine model. Five of the 22 dogs survived with good function of the autograft as determined by glucose homeostasis and a slow return to normal of serum amylase levels. In 12 dogs, however, pancreatic dysfunction was evident within 24 hours and death followed within days. At reexploration or necropsy, necrotic pancreatic tissue and clotted vessels were found. We suggest from these findings that although few, if any, complications of exocrine drainage or endocrine function were encountered, a major technical problem with segmental pancreatic transplantation may involve inadequate arterial runoff to maintain patency of vessels and viability of the graft. Terminal arteriovenous fistulas do not seem to improve vascular patency in the canine model in our experience.