title: Conservative Pancreas Graft Preservation at the Extreme.
abstract: Because of the value some patients place in remaining insulin-independent after pancreas transplantation, they may be reluctant to undergo graft pancreatectomy, even in the face of extreme complications, such as graft thrombosis and duodenal segment leak. Partly, for this reason, a variety of complex salvage techniques have been described to save the graft in such circumstances. We report a case of a series of extreme complications related to a leak from the duodenal segment after a simultaneous pancreas and kidney transplant. These included infected thrombosis of the inferior vena cava associated with a graft venous thrombosis and a retroperitoneal fistula. The patient retained graft function with insulin independence and repeatedly declined graft pancreatectomy against the advice of the transplant team. Conservative treatment with percutaneous drainage, antibiotics, and anticoagulation was eventually successful. This outcome is unique in our experience and may be instructive to teams caring for pancreas transplant recipients.
authors: Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.; RPA Institute of Academic Surgery, Royal Prince Alfred Hospital, University of Sydney, New South Wales, Australia.
authors: Jerome Martin
authors: JM
authors: Laurence
authors: Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors: Gonzalo
authors: G
authors: Sapisochin
authors: Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors: Markus
authors: M
authors: Selzner
authors: Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors: Andrea
authors: A
authors: Norgate
authors: Department of Medicine, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors: Deepali
authors: D
authors: Kumar
authors: Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors: Ian D
authors: ID
authors: McGilvary
authors: Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors: Paul D
authors: PD
authors: Preig
authors: RPA Institute of Academic Surgery, Royal Prince Alfred Hospital, University of Sydney, New South Wales, Australia.
authors: Jeffrey
authors: J
authors: Schiff
authors: Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors: Mark S
authors: MS
authors: Cattral