Revascularization of the gastroepiploic artery in pancreas transplant
Thrombosis accounted for 52.0% of all transplant failures in one recent large series and is felt to result from devascularization of the pancreas during organ procurement. A technique to revascularize the pancreas is described. The operative notes and angiograms of 110 consecutive pancreas transplants were reviewed. Eight pancreata were found deprived of blood supply to the head and the neck of the pancreas on indigocarmine-renograffin table angiograms. During back table reconstruction a distal branch of the superior mesenteric artery (SMA) was dissected and anastomosed end to end to the gastroepiploic artery using 8–0 monofilament suture. Repeated table angiogram showed excellent blood supply to the head of the pancreas, the duodenum and the body and tail of the pancreas. The pancreas transplantation proceeded with iliac artery graft inflow, portal venous outflow and enteric drainage. Simultaneous quadruple therapy with thymoglobulin, CNI, MMF and a 4-day course of steroids was used. All patients became insulin independent and euglycemic. No duodenal leak was observed in the entire series. In summary, 1-ligation of the gastroduodenal artery (GDA) is not a safe procedure, especially when arterial blood supply from the inferior pancreaticoduodenal artery is poor or inexistent, 2-table angiogram helps delineate the high risk hypo-perfused pancreas, 3-preservation of the right gastroepiploic artery and the branches of the SMA allows an easy revascularization of the pancreatic graft.