Pancreas Transplantation with Duodeno-Duodenal Anastomosis: A Single-Center Experience

Abstract

Introduction: Techniques such as retroperitoneal graft placement have further improved the ability to reproduce the physiology of the “native” pancreas. We herein present our experience of a technique for pancreatic transplant, with the organ placed into a fully retroperitoneal position with systemic venous and enteric drainage of the graft by duodenoduodenostomy. Methods: All pancreas transplantations performed between May 2016 and July 2021 were prospectively entered into our transplant database and retrospectively analyzed. Results: A total of 81 transplants were performed using the duodenoduodenostomy (43 men: median age of 42 years [IQR 36-50]). Median cold ischemia times was 9 hours [IQR 7-10.4]. The preservation solution used was Celsior (n=19), IGL-1 (n=49), and UW (n=13). Regarding morbidity, 43.2% of patients presented pancreas related complications: abdominal hemorrhage (n=8, 9.9%); graft pancreatitis (n=5, 6.2%); fluid collections (n=9, 11.1%); and vascular thrombosis (n=20, 24.7%). Intestinal complications (n=7, 8.6%) were: intestinal obstruction (n=2); paralytic ileus (n=2); dehiscence in duodenum after pancreas transplantectomy (n=1); dehiscence of duodeno-duodenostomy (n=2). Of these, four cases required relaparotomy: adhesiolysis (n=2); transplantectomy (n=1); primary leak closure (n=1). According to the Clavien-Dindo classification, pancreas complications were: Grade I: 3.7 %, Grade-II: 13.6 %, and Grade IIIa:4.9%, Grade IIIb: 21%. The median hospital stay was 13.5 days. After a median follow-up of 30.7 months [IQR 18.1-44], the 1 and 3-year graft survival was 89.5%, respectively, with no patient mortality. Conclusions: Retroperitoneal graft placement with duodenoduodenostomy is safe and feasible, with a low rate of intra-abdominal complications, providing competitive results in terms of graft/patient survival.