Surgical Techniques for Pancreas Transplantation

Summary: Background: Pancreas transplantation is the only treatment of IDDM (Type I diabetes) that consistently establishes insulin independence with complete normalization of HbA1c levels. Methods: The currently applied techniques for organ procurement, bench reconstruction and implantation of pancreatic transplantation with reference to our own experience with more than 200 pancreas transplants are reviewed. Results: To date, the majority of transplant centres prefer enteric drainage of the exocrine secretion and either systemic or portal endocrine drainage in simultaneous pancreas-kidney transplants, whereas bladder drainage is preferentially applied in solitary pancreas transplants. This change in the exocrine diversion technique resulted in a different pattern of posttransplant surgical complications. Causes for reoperation include vascular graft thrombosis, bleeding, pancreatitis and leaks at the site of the duodenal segment with intra-abdominal infection (IAI) and sepsis. Conclusions: Improvements in organ preservation, surgical technique and maintenance immunosuppression including the new agents Tacrolimus (FK-506) and MMF (CellCept®) resulted in significantly better graft survival following combined pancreas-kidney but also solitary pancreas transplantation, which in turn led to an increase in pancreas transplant activities worldwide.