Should the Pancreas be Routinely Included with an Intestinal Graft?

Abstract

Intestinal transplant is the only curative solution for children and adults with life-threatening complications of intestinal failure. A dilemma that arises often in real life, typically at the time of organ allocation involving multiple centers, is whether the pancreas can and/or should be procured and transplanted separately from an intestine-containing graft. Evidence appears to support routinely allocating the pancreas along with a composite liver-intestine graft. For all pediatric recipients and recipients of any age requiring foregut replacement, the pancreas would likewise seem fundamental to the graft. The only scenario where the pancreas might not be considered as integral to the graft is an isolated intestine transplant where the recipient does not require the foregut. We feel that the pancreas should generally be allocated with isolated intestine grafts in adults, as the added benefit to the pancreas recipient pool is not adequately offset by the risk to the intestine recipients.