343.11: New Arterial Reconstruction Technique Among Simultaneous Pancreas-Kidney (SPK) Transplantation: A Randomized Clinical Trial

Abstract

Introduction: Pancreas transplant is the most physiologic therapy for the diabetic patient.Pancreas transplantation is most commonly performed in conjunction with a kidney transplant, a procedure referred to as simultaneous pancreas-kidney (SPK) transplantation. Despite over two decades of experience and the considerable refinements in the surgical techniques, the operation still carries a high morbidity. It theorized that surgical complications following SPK result from the devascularization of the pancreas allograft during the combined liver-pancreas procurement.In this study we are approaching a new arterial reconstruction technique amongst SPK aiming to reduce pancreatic manipulation hence postoperative complications. Methods: This Trial was performed in from October 2020 to December 2021 in Shiraz Transplant Center, Shiraz, Iran. Inclusion criteria was all patients over 18 years of age undergone SPK tx due to diabetic nephropathy. For venous anastomosis, the superior mesenteric vein (SMV) is clamped at the mesenteric root. After venotomy of SMV, an end-to-side anastomosis is performed from the portal vein to SMV with standard vascular anastomosis technique. then the patients rendomized for Arterial reconstruction: arterial reconstruction is performed with a Y graft anastomosis to the right common iliac artery (CIA) or, a Y graft with two short arms is selected in a bench surgery, and an extension graft from the carotid is prepared for anastomosis to the CIA. The primary outcomes were evaluatation of postoperative complications such as pancreatitis, vascular events, fistula formation, intra-abdominal bleeding, and rejection in the first six months after SPK transplantation in these two different arterial reconstruction technique. Results: A total of 30 patients were included in this study, of which 15 were in each group. The mean age of patients was 33.3 ± 6.3 years.19 patients were male and 11 patients were female. Table 1 shows demographic data between the two groups. According to results of table 2, rate of pancreatitis,vascular events and rejection was less in the Y- graft and extension technique,although this difference was not statistically significant.No mortality was observed during the study period. Cohen’s coefficient for Y graft and extension technique regarding pancreatitis, venous thrombosis,rejection was 0.5, 0.57 and 0.61, respectively which means a medium-sized effect. Conclusion: The results of our study showed that the Y- graft and extension technique reduces postoperative complications such as pancreatitis, vascular events and rejection without increasing the lenght of surgery time.