En bloc retroperitoneal pancreas-kidney transplantation with duodenoduodenostomy using pediatric organs.
BACKGROUND
Given the shortage of organ donors, there is a critical need to use all available pancreas grafts for transplantation. In the Eurotransplant region, only 26% of all offered pancreas grafts were transplanted during 2007. Pediatric donors are rarely used in pancreas transplantation.


METHODS
In this case report, we describe a retroperitoneal en bloc pancreas-kidney transplantation (SPK) with systemic venous anastomosis and duodenoduodenostomy using grafts from an 11-year-old child. The bloc was transplanted in a 42-year-old type I diabetic patient with end-stage renal disease. The proximal end of the aortic graft was closed. Arterial anastomosis was performed end-to-end between right internal iliac artery and the aortic graft because of severe atherosclerosis. Donor portal vein and donor renal vein were anastomosed separately end-to-side to recipient inferior vena cava. Exocrine drainage was carried out with a side-to-side duodenoduodenostomy. Both grafts were in the retroperitoneal position.


RESULTS
The pancreas graft functioned immediately, the kidney graft resumed function at 7 days posttransplantation. Graft function was excellent over a follow-up of 18 months. The patient had no episodes of acute rejection or graft dysfunction, no severe infections, and no additional morbidity from the modified technique of retroperitoneal pancreas transplantation using duodenoduodenostomy.


CONCLUSIONS
This case indicates that pediatric donors could be used more frequently in pancreas transplantation for adult recipients and could increase the organ donor pool. En bloc SPK is a feasible and safe technique. Further studies are required to confirm the benefits of a retroperitoneal SPK using duodenoduodenostomy.
Schenker
P
P
Department of Surgery, Knappschafts-Hospital, Ruhr-University of Bochum, Düsseldorf, Germany. Peter.Schenker@rub.de
Flecken
M
M
Vonend
O
O
Wunsch
A
A
Traska
T
T
Viebahn
R
R
D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D002648:Child; D003928:Diabetic Nephropathies / Q000601:surgery*; D004385:Duodenostomy / Q000379:methods*; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000276:immunology / Q000379:methods*; D008297:Male; D009929:Organ Size; D016035:Pancreas Transplantation / Q000276:immunology / Q000379:methods*; D011169:Portal Vein / Q000601:surgery; D012082:Renal Veins / Q000601:surgery; D014019:Tissue Donors / Q000706:statistics & numerical data*; D014682:Vena Cava, Inferior / Q000601:surgery
D007166:Immunosuppressive Agents