PANCREAS TRANSPLANTATION FROM DONORS PLANNED FOR CONCURRENT PROCUREMENT OF FIVE ABDOMINAL GRAFTS TO BE TRANSPLANTED TO DIFFERENT RECIPIENTS

Abstract

A15 Aims: Shortage of suitable donors mandates that procurement (Pr) of multiple abdominal grafts be always pursued. Pancreas Pr can be made more technically demanding and/or pancreas transplantation (PTx) can be thought at higher risk of technical failure, when the donor was planned for concurrent Pr of the small bowel and/or for in situ split of the liver. We herein describe our experience with pancreas Pr from patients who donated at least 5 abdominal grafts. Methods: Between October 2000 and March 2004 a total of 125 PTx were performed at our Institution. In 10 donors (8%) the pancreas was procured simultaneously with at least other 4 abdominal grafts including kidneys, full size liver or two hemilivers, and/or small bowel. Donor population comprised 6 males and 9 females, aged between 9 and 40 years (average: 22.4 years) with a mean body max index of 22.1 kg/m2 (range 15.1-27.6 kg/m2). Five donors died of cerebrovascular disease and 5 due to head trauma. Lenght of intensive care unit stay averaged 3.0 days (range 1–6 days), 2 donors were under multiple vasopressors and 1 had 4 episodes of cardiac arrest. Vascular variations in liver supply were identified in 3 donors, including 2 replaced right hepatic arteries arising from the superior mesenteric artery. Donors were selected for PTx according to standard criteria irrespective of the number of other abdominal grafts procured concurrently. Results: All pancreata were procured and transplanted as planned. Overall, 50 abdominal grafts were procured and transplanted including 10 pancreata, 20 kidneys, 3 full size livers, 14 hemilivers, and 3 isolated small bowel grafts. Pancreata were reperfused after a mean cold ischemia time of 674 min. (range: 485–900 min.) and were drained either in the portal vein (n=7) or in the systemic circulation (n= 3). All grafts functioned immediately and quickly restored euglycemia. No graft pancreatitis occurred and no pancreas was lost due to vascular thrombosis. Pancreatic enzymes peaked to a mean of 237.9 U/L for amilase and 170.3. U/L for lipase and always returned within the normal range by post-transplant day 5 (n. v.: amilase <100 U/L; lipase <60 U/L). One graft was lost in the early post-transplant period due to hyperacute/accelerated rejection. This patients required allograft pancreatectomy, giving an overall relaparotomy rate of 10%. After a mean follow-up period of 28.3 months (range 0.5–41.6 months) 1 further graft was lost due to chronic rejection 14 months after PTx. No further pancreas rejection episodes were diagnosed. Actuarial 1- and 3-year pantient survival rates were both 100%. Equivalent figures for pancreata were 90.0% and 78.7%, respectively. Conclusions: Improved success of PTx makes pancreas Pr mandatory to meet the continuously growing demand. Our experience provides futher evidence supporting that pancreas Pr and technically successful PTx are both possible even when the donor is planned for concurrent Pr of multiple grafts including those that are not retrieved routinely.