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Pancreas transplant

From Surgopaedia

History

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  • First performed 1966
  • 1985 - bladder drainage of exocrine secretions introduced
  • Now - mostly enteric drainage

Patient selection

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  • Patients with diabetes who have had progressive signs of tissue injury under appropriate medical management
    • Retinopathy
    • Neuropathy
    • Gastroparesis/enteroparesis
    • Progressive autonomic dysfunction
    • Hypoglycaemic unawareness
    • Nephropathy (simultaneous kidney and pancreas transplant)
  • Either type 1 or type 2
  • Not obese
  • Younger than 55

Types of transplant

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  • Simultaneous kidney and pancreas (80%, in setting T1DM and ESRF)
  • Pancreas after kidney
  • Pancreas alone
  • Alloislet (only experimental)
  • Autoislet (really an adjunct treatment for chronic pancreatitis)

Technique

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  • Midline incision from pubis to just above umbilicus
  • Arterial anastomosis between Y-graft, fashioned from donor common iliac, and the recipient common iliac
  • Anastomose duodenal C-loop side-to-side with a piece of jejunum about 50cm distal to ligament of Treitz
  • Donor PV attached to recipient SMV

Complications

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  • Haemorrhage
  • Thrombosis
  • Anastomotic leak
  • Pancreatitis
  • Rejection

Islet allotransplantation

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  • First done in 1970s
  • More research necessary but very promising
  • Infiltrate via portal vein (IR), so they get embedded in liver
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