BENCH RECONSTRUCTION OF PANCREAS FOR TRANSPLANTATION - EXPERIENCE WITH 192 CASES

Whole organ pancreaticoduodenal transplantation with bladder drainage by the duodenal segment technique is currently the preferred method of vascularized pancreas transplantation but is associated with a finite risk of surgical complications. Meticulous bench reconstruction of th e pancreaticoduodenal allograft may minimize complications following t ransplantation. Over a 6.5-yr period, 192 pancreas transplants were pe rformed in 181 diabetic patients by the same transplant team. A retros pective review was performed in order to describe a stepwise approach to bench preparation of the pancreaticoduodenal allograft that has dev eloped from this experience. In this series of 192 consecutive pancrea ticoduodenal reconstructions, no procured pancreas was deemed non-usab le solely from an anatomic standpoint. The mean backtable pancreas pre paration time was 2 h. The operative complication rate was 19%, the in cidence of technical graft loss was 6.8%, and there was no mortality r elated to technical problems. Conclusions: Using a standardized approa ch, meticulous bench reconstruction of the pancreaticoduodenal allogra ft: 1) can be performed in virtually any anatomic setting; 2) decrease s complications following transplantation; 3) improves initial allogra ft function; and 4) minimizes organ wastage.