The experience of pancreas transplantation with isolated splenic artery supply

Cover Page

Cite item

Full Text

Abstract

Aim. To demonstrate the possibility of successful transplantation of pancreaticoduodenal complex with isolated splenic artery supply and to assess the quality of its perfusion.

Methods. 6 patients who underwent pancreas transplantation with isolated splenic artery blood supply were examined. The recipients were 3 men and 3 women, the median age was 36.5 [31; 42] years. To evaluate the state, quality of transplant perfusion and their function, the laboratory data, doppler ultrasound, measurement of blood flow volume (CT-perfusion) and treatment outcomes were assessed.

Results. Based on the results of investigations, adequate pancreatic graft blood supply through the splenic artery alone was detected. Pancreatic transplant function in all patients was satisfactory, blood glucose levels remained within normal values. Hospital mortality was 0%.

Conclusion. Successful transplantation of pancreaticoduodenal complex with isolated splenic artery supply is technically possible due to the presence of intraorganic arterial collaterals.

About the authors

A V Pinchuk

N.V. Sclifosovsky Research Institute of Emergency Medicine; Moscow State University of Medicine and Dentistry; Scientific Research Institute of Health Organization and Medical Management

Author for correspondence.
Email: anisimovya@sklif.mos.ru
Moscow, Russia; Moscow, Russia; Moscow, Russia

Yu A Anisimov

N.V. Sclifosovsky Research Institute of Emergency Medicine

Email: anisimovya@sklif.mos.ru
Moscow, Russia

I V Dmitriev

N.V. Sclifosovsky Research Institute of Emergency Medicine

Email: anisimovya@sklif.mos.ru
Moscow, Russia

R V Storozhev

N.V. Sclifosovsky Research Institute of Emergency Medicine

Email: anisimovya@sklif.mos.ru
Moscow, Russia

A G Balkarov

N.V. Sclifosovsky Research Institute of Emergency Medicine

Email: anisimovya@sklif.mos.ru
Moscow, Russia

R Sh Muslimov

N.V. Sclifosovsky Research Institute of Emergency Medicine

Email: anisimovya@sklif.mos.ru
Moscow, Russia

I V Khodilina

N.V. Sclifosovsky Research Institute of Emergency Medicine

Email: anisimovya@sklif.mos.ru
Moscow, Russia

References

  1. Leone J.P., Christensen K. Postoperative manage­ment. In: Gruessner R.W.G., Sutherland D.E.R. eds. Transplantation of the pancreas. New York: Springer. 2004; 206–237. doi: 10.1007/978-1-4757-4371-5_9.
  2. Oberholzer J., Tzvetanov I.G., Benedetti E. Surgical complications of pancreas transplantation. In: Hakim N.S., Stratta R.J., Gray D., Friend P., Coleman A. eds. Pan­creas, islet, and stem cell transplantation for diabetes. 2nd ed. Oxford university press. 2010; 179–189. doi: 10.1093/med/9780199565863.003.0011.
  3. Corry R.J., Shapiro R. Pancreatic transplantation. New York: Informa Healthcare. 2007; 159–170.
  4. Srinivas T.R., Shoskes D.A. Kidney and pan­creas transplantation. A practical guide. New York: Humana press. 2011; 442 р. doi: 10.1007/978-1-60761-642-9.
  5. Nghiem D.D. Revascularization of the gastroepi­ploic artery in pancreas transplant. Transpl. Int. 2008; 21 (8): 774–777. doi: 10.1111/j.1432-2277.2008.00683.x.
  6. Walter M., Jazra M., Kykalos S. et al. 125 cases of duodenoduodenostomy in pancreas transplantation: a ­single-
  7. centre experience of an alternative enteric drainage. Transpl.
  8. Int. 2014; 27 (8): 805–815. doi: 10.1111/tri.12337.
  9. Boggi U., Vistoli F., Signori S. et al. Outcome of 118 pancreas transplants with retroperitoneal portal-enteric drainage. Transplant. Proc. 2005; 37 (6): 2648–2650. doi: 10.1016/j.transproceed.2005.06.081.
  10. Moya-Herraiz A., Muñoz-Bellvis L., Ferrer-Fábrega J. et al. Cooperative study of the Spanish Pancreas Transplant Group (GETP): Surgical complications. Cir. Esp. 2015; 93 (5): 300–306. doi: 10.1016/j.ciresp.2014.12.006.
  11. Adamec M., Janousek L., Saudek F., Tosenovský P. 100 pancreas transplantations with extraperitoneal graft placement. Ann. Transplant. 2001; 6 (2): 41–42. PMID: 11803618.
  12. Hummel R., Langer M., Wolters H.H. et al. Exocrine drainage into the duodenum: a novel technique for pan­creas transplantation. Transpl. Int. 2008; 21 (2): ­178–181. doi: 10.1111/j.1432-2277.2007.00591.x.
  13. Li J.Q., He Z.J., Si Z.Z. et al. Gastroduodenal arterial reconstruction of the pancreaticoduodenal allograft. Transplant. Proc. 2011; 43 (10): 3905–3907. DOI: 10.1016/
  14. j.transproceed.2011.10.043.
  15. Baranski A. Khirurgicheskaya tekhnika eksplantatsii donorskikh organov. (Surgical technique of the abdominal organ procurement.) Moscow: GEOTAR-Media. 2014; 224 р. (In Russ.)
  16. Farghadani M., Momeni M., Hekmatnia A. et al. Anatomical variation of celiac axis, superior mesente­ric artery, and hepatic artery: Evaluation with multidetector computed tomography angiography. J. Res. Med. Sci. 2016; 21: 129. doi: 10.4103/1735-1995.1.
  17. Rafailidis V., Papadopoulos G., Kouskouras K. et al. Multiple variations of the coeliac axis, hepatic and renal vasculature as incidental findings illustrated by MDCTA. Surg. Radiol. Anat. 2016; 38 (6): 741–745. doi: 10.1007/s00276-015-1598-1.
  18. Yamaguchi H., Wakiguchi S., Murakami G. et al. Blood supply to the duodenal papilla and the communicating artery between the anterior and posterior pancreaticoduodenal arterial arcades. J. Hepatobiliary Pancreat. Surg. 2001; 8 (3): 238–244. doi: 10.1007/s0053410080238.
  19. Socci C., Orsenigo E., Zuber V. Triple arterial reconstruction improves vascularization of whole pancreas for transplantation. Transplant. Proc. 2006; 38 (4): ­1158–1159. doi: 10.1016/j.transproceed.2006.02.020.
  20. Badosa F., Baquero A., Cope C. et al. Arterial supply to the pancreas: anatomic variations pertinent to whole organ transplantation. Transplant. Proc. 1987; 19 (5): ­3937–3938. PMID: 3313968.
  21. Ibukuro K. Vascular anatomy of the pancreas and clinical applications. Int. J. Gastrointest. Cancer. 2001; 30 (1–2): 87–104. doi: 10.1385/IJGC:30:1-2:087.
  22. Mercer D.F., Rigley T., Stevens R.B. Extended donor iliac arterial patch for vascular reconstruction during pancreas transplantation. Am. J. Transplant. 2004; 4 (5): 834–837. doi: 10.1111/j.1600-6143.2004.00422.x.
  23. Yang H.C., Gifford R.R., Dafoe D.C. et al. Arterial reconstruction of the pancreatic allograft for transplantation. Am. J. Surg. 1991; 162 (3): 262–264. doi: 10.1016/0002-9610(91)90083-P.
  24. Fernández-Cruz L., Astudillo E., Sanfey H. et al. Combined whole pancreas and liver retrieval: comparison between Y-iliac graft and splenomesenteric anastomosis. Transpl. Int. 1992; 5 (1): 54–56. doi: 10.1111/j.1432-2277.1992.tb01724.x.
  25. Nerestyuk Y.I. CT Perfusion of pancreatic tumors. Meditsinskaya visualizatsiya. 2015; (3): 57–67. (In Russ.)
  26. Muslimov R.Sh., Ternovoy S.K., Serova N.S. et al. A technique of evaluating of pancreas graft perfusion using dyna­mic volume computed tomography. REJR. 2017; 7 (4): 74–82. (In Russ.)

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

© 2019 Pinchuk A.V., Anisimov Y.A., Dmitriev I.V., Storozhev R.V., Balkarov A.G., Muslimov R.S., Khodilina I.V.

Creative Commons License

This work is licensed
under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.




This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies