Bench reconstruction of pancreas for transplantation: experience with 192 cases

Whole organ pancreaticoduodenal transplantation with bladder drainage by the duodenal segment technique is currently the preferred method of vascularized pancreas transplantation but is associated with a finite risk of surgical complications. Meticulous bench reconstruction of the pancreaticoduodenal allograft may minimize complications following transplantation. Over a 6.5-yr period, 192 pancreas transplants were performed in 181 diabetic patients by the same transplant team. A retrospective review was performed in order to describe a stepwise approach to bench preparation of the pancreaticoduodenal allograft that has developed from this experience. In this series of 192 consecutive pancreaticoduodenal reconstructions, no procured pancreas was deemed non-usable solely from an anatomic standpoint. The mean backtable pancreas preparation time was 2 h. The operative complication rate 19%, the incidence of technical graft loss was 6.8%, and there was no mortality related to technical problems.

Using a standardized approach, meticulous bench reconstruction of the pancreaticoduodenal allograft: 1) can be performed in virtually any anatomic setting; 2) decrease complications following transplantation; 3) improves initial allograft function; and 4) minimizes organ wastage.