The Back Table Graft Arterial Anastomosis Between Splenic Artery and Superior Mesenteric Artery: A 13-Year Single-Center Experience of Pancreas Transplantation in Barcelona.

Abstract

Introduction:Vascular complications following pancreas transplantation are the leading non-immunologic cause of graft loss.The arterial vascular reconstruction including a Y-graft interposition from the donor iliac artery bifurcation is the most used worldwide. Aim:We sought to assess the incidence of vascular complications after using the back-table graft arterial anastomosis between splenic artery (SA) and distal superior mesenteric artery (SMA). Methods:This was a retrospective analysis including all pancreas transplants performed over 13 years (2001-2013).For the bench reconstruction, the SMA was distally dissected and sewn to the SA in an end-to-end fashion (SMA/SA).The proximal SMA with an aortic patch was anastomosed to the recipient common iliac artery. In a few cases the arteries were reconstructed with an iliac arterial “Y” graft. Vascular complications were included, focusing on arterial events. Results: A total of 273 pancreas transplantations were done:223 simultaneous pancreas kidney, 2 pancreas alone,17 pancreas after kidney and 31 retransplantations. At the bench procedure SMA/SA anastomosis was performed in 92.3% of the patients, arterial iliac “Y” graft in 17 patients,and no arterial reconstruction was need in 4 patients because of anatomical variations of the donor pancreas. Sixty-six patients presented vascular complications;venous complications were the most frequent (53 recipients).There were 16 patients with arterial complications (5.55% SMA/SA, 11.76% Y-graft).Eleven were acute arterial complications (1 enteric anastomosis bleeding with SMA thrombosis and 10 thrombosis).Five patients presented late arterial complications(Chronic arterial thrombosis (1);arterial anastomosis pseudoaneurism(1);enteroarterial fistula (3)).The patient survival with SMA/SA anastomosis at 1st and 5th year was 98.8% and 95.4%.The patient survival for arterial “Y” Graft was 100% at 1st and 93 % the 5th year.The graft survival with SMA/SA anastomosis at 1st and 5th year was 87.2% and 76.7%; and 93% using arterial “Y” Graft. Conclusions:The back table procedure used in our institution (SMA/SA) is an easy, effective and safe surgical technique, that can be used as a good alternative for surgeons to arterial “Y” graft.