A “Pancreatectomy First" Approach Improves Both Hepatectomy and Pancreatectomy Times in Cadaveric Multi-organ Abdominal Retrieval

Abstract

Introduction: The aim of organ retrieval is safe procurement of transplantable organs with acceptable warm ischaemia times. In the United Kingdom, organ retrieval is a centrally coordinated service delivered by 10 teams. Despite this, there is no standardised retrieval technique. Practiced techniques include hepatectomy first or en-bloc organ retrieval. Hepatectomy first approach exposes the pancreas to prolonged warm ischaemia while the liver is being retrieved and packed. While the en-bloc technique ensures swift and timely removal of both organs, extra time is spent at the back-table splitting the organs. We report on the Manchester “pancreatectomy first approach” which we believe is safe and time efficient for both organs. Methods: A retrospective analysis of a prospectively maintained database of a single centre's organ retrieval activity between 2016-2019 was performed. Primary outcomes were hepatectomy and pancreatectomy times. Secondary outcomes were organ damage and transplant outcomes. Results: 546 donor operations were conducted. Using the hepatectomy first approach, mean hepatectomy time when performing liver alone was comparable to liver/pancreas (30mins vs 33mins). The proportion taking more then 30 minutes increased when both organs were retrieved (41.3% vs 56.3%). Mean pancreatectomy time was 14mins after hepatectomy. 10 operations were performed using a “pancreatectomy first” approach. Median pancreatectomy time was 21 minutes with hepatectomy occurring 6 minutes later. There was no difference in organ damage or transplant outcomes. Conclusion: This small case series suggests that a pancreatectomy first approach at multi-organ retrieval is feasible, safe, efficient, and reduces warm ischaemia times for both liver and pancreas.