title: Pancreatic graft survival despite partial vascular graft thrombosis due to splenocephalic anastomoses.
abstract: Thrombotic complications following pancreas transplantation are still the most common cause of nonimmunologic graft loss. The aim of this study was to analyze pancreatic graft function after partial arterial graft thrombosis and the investigation of the pancreatic arterial anatomy with regard to intraparenchymal anastomoses. We retrospectively analyzed the data for 175 consecutive pancreas transplants performed between January 2002 and October 2007. Selective Y-graft angiography was performed in 10 and rubber-milk injection in 5 fresh pancreas specimens. Thrombosis of one leg of the Y-graft was diagnosed in 18 (10.3%) patients. Only one of these patients with thrombosis of the splenic artery required exogenous insulin. Sufficient graft perfusion was demonstrated in all of the remaining grafts. One graft was lost due to acute rejection. In all specimens angiography showed an excellent perfusion of the pancreaticoduodenal arcade, even after selective cannulation of the splenic artery. Arterial collaterals between the gastroduodenal, splenic artery and the superior mesenteric artery were demonstrated. Our results demonstrate that global perfusion of the pancreatic graft and sufficient graft function is sustained after the thrombotic occlusion of one branch of the Y-graft by a complex system of intraparenchymal anastomoses. These anatomical findings may have consequences for resection strategies in pancreas surgery.
authors.affiliation: Department of Visceral, Transplant and Thoracic Surgery.
authors.forename: C
authors.initials: C
authors.lastname: Margreiter
authors.affiliation: Department of Visceral, Transplant and Thoracic Surgery.
authors.forename: W
authors.initials: W
authors.lastname: Mark
authors.affiliation: University Clinic of Cardiac Surgery.
authors.forename: D
authors.initials: D
authors.lastname: Wiedemann
authors.affiliation: Department of Visceral, Transplant and Thoracic Surgery.
authors.forename: R
authors.initials: R
authors.lastname: Sucher
authors.affiliation: Department of Visceral, Transplant and Thoracic Surgery.
authors.forename: R
authors.initials: R
authors.lastname: Öllinger
authors.affiliation: Department of Visceral, Transplant and Thoracic Surgery.
authors.forename: C
authors.initials: C
authors.lastname: Bösmüller
authors.affiliation: Department of Diagnostic Radiology.
authors.forename: M
authors.initials: M
authors.lastname: Freund
authors.affiliation: Department of Visceral, Transplant and Thoracic Surgery.
authors.forename: H T
authors.initials: HT
authors.lastname: Maier
authors.affiliation: Department of Vascular Surgery.
authors.forename: A
authors.initials: A
authors.lastname: Greiner
authors.affiliation: Department of Anatomy, Histology and Embryology, Division of Clinical and Functional Anatomy, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: H
authors.initials: H
authors.lastname: Fritsch
authors.affiliation: Department of Visceral, Transplant and Thoracic Surgery.
authors.forename: J
authors.initials: J
authors.lastname: Pratschke
authors.affiliation: Department of Visceral, Transplant and Thoracic Surgery.
authors.forename: R
authors.initials: R
authors.lastname: Margreiter
authors.affiliation: Department of Visceral, Transplant and Thoracic Surgery.
authors.forename: F
authors.initials: F
authors.lastname: Aigner
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D005260:Female; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation; D013154:Spleen / Q000473:pathology*; D013927:Thrombosis / Q000150:complications*