Reduced the Occurrence of Graft Thrombosis Using the Technique of Allograft “Triple Inflow” Arterial Reconstruction for Pancreas Transplantation

Abstract

Graft thrombosis (GT) accounts for the majority of graft loss in the early postoperative phase of pancreas transplantation (PT). Low microvascular flow in the allograft makes it vulnerable to GT. The technique of allograft "dual inflow" (DI) arterial reconstruction is currently practiced. We herein describe another technique of allograft "triple inflow" (TI) arterial reconstruction to reduce the occurrence of GT. Of the last 33 PT (26 simultaneous pancreas-kidney transplants, 6 pancreas-after-kidney transplants and 1 pancreas transplant alone) in our center, the techniques of DI and TI were used in 22 and 11 allografts separately. The DI technique includes ligation and division of the gastroduodenal artery (GDA) followed by anastomoses of the superior mesenteric artery (SMA) and splenic artery (SA) of the pancreatic graft to the external iliac artery (EIA) and internal iliac artery (IIA) of the donor “Y” iliac artery (YIA). The TI technique includes preservation of the GDA during procurement. More branches of the donor YIA are preserved. Of these branches, the largest small branch (BIA) is used for the “third” anastomosis to the GDA of the pancreatic graft as well as with the SMA and SA anastomoses described in the DI technique. (Fig.) Following PT, 3 of 22 (13.6%) allografts using DI technique developed GT 24-48 hours postoperatively which resulted in graft losses. None of the 11 allografts using TI technique developed GT. The technique of allograft TI arterial reconstruction used for PT increases blood flow to the pancreas transplant and reduces the risk of GT.