Pancreas Transplantation From Very Small Pediatric Donor Using the "Cephalic Placement" Technique: A Case Report.
BACKGROUND
The gap between the number of diabetic patients on the waiting list for transplantation and the number of pancreas donors is growing and it is mandatory to extend criteria for donor eligibility. Several reports showed the feasibility of pancreas transplantation from pediatric donors with comparable outcomes to adult donors in terms of long-term β-cell function. However, there is no consensus about donor age and weight limits.


METHODS
We present two cases of pancreas transplantation alone (PTA) from very small pediatric donors: a 2-year-old female (weight 13 kg, height 88 cm) and a 6-year-old male (weight 29 kg, height 122 cm). We used a novel "cephalic placement" technique. The pancreas was placed upon the aortic carrefour with cephalic pole upward with 3 anchorage points: the left common iliac vein (or the inferior cava vein), the right common iliac artery, and an ileal loop.


RESULTS
No postoperative thrombosis occurred and the patients gained insulin independence instantaneously. CT scan performed on postoperative day 3 showed regular organ perfusion in both cases. Graft volume and surface calculated by CT reconstruction were, respectively, 25 cc and 89 cm(2) in the first case, and 46.5 cc and 123 cm(2) in the second case. Postoperative mixed meal tolerance tests showed normal glycemic profile. Patients are actually insulin independent at 4 years and 8 months.


CONCLUSIONS
Pancreases from very young pediatric donors are adequate to restore insulin independence after PTA in adult patients. The "cephalic placement" technique is feasible and effective using very small pancreases.
Unit of Bariatric and Transplant Surgery, Division of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy.
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Chiari
Unit of Bariatric and Transplant Surgery, Division of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy.
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Bissolati
Unit of Bariatric and Transplant Surgery, Division of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy.
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Gazzetta
Unit of Bariatric and Transplant Surgery, Division of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy.
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Guarneri
Unit of Bariatric and Transplant Surgery, Division of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy.
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Tomanin
Transplant Medicine Unit, San Raffaele Hospital, Milan, Italy.
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Maffi
Transplant Medicine Unit, San Raffaele Hospital, Milan, Italy.
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Secchi
Unit of Bariatric and Transplant Surgery, Division of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy.
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Rosati
Unit of Bariatric and Transplant Surgery, Division of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy. Electronic address: socci.carlo@hsr.it.
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Socci
D000328:Adult; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery*; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery; D007083:Iliac Artery / Q000601:surgery; D007084:Iliac Vein / Q000601:surgery; D008297:Male; D009929:Organ Size; D010179:Pancreas / Q000033:anatomy & histology*; D016035:Pancreas Transplantation / Q000379:methods*; D014019:Tissue Donors