title: Pancreas Transplant with Duodeno-Duodenostomy and Caval Drainage Using a Diamond Patch Graft: A Single-Center Experience.
abstract: BACKGROUND The surgical technique used in pancreas transplant is essential for patient safety and graft survival, and problems exist with conventional strategies. When enteric exocrine drainage is performed, there is no method of immunologic monitoring other than direct graft pancreas biopsy. The most common cause of early graft failure is graft thrombosis, and adequate preventive and treatment strategies are unclear. To overcome these disadvantages, we suggest a modified surgical technique. MATERIAL AND METHODS Eleven patients underwent pancreas transplant with our modified technique. The modified surgical techniques are as follows: 1) graft duodenum was anastomosed with recipient duodenum to enable endoscopic immunological monitoring, and 2) the inferior vena cava was chosen for vascular anastomosis and a diamond-shaped patch was applied to prevent graft thrombosis. RESULTS No patient mortality or graft failure occurred. One case of partial thrombosis of the graft portal vein occurred, which did not affect graft condition, and resolved after heparin treatment. All patients were cured from diabetes mellitus. There were no cases of pancreatic rejection, but 2 cases of graft duodenal rejection occurred, which were adequately treated with steroid therapy. CONCLUSIONS This modified surgical technique for pancreas transplant represents a feasible method for preventing thrombosis and allows for direct graft monitoring through endoscopy.
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea.|Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea.
authors.forename: Je Ho
authors.initials: JH
authors.lastname: Ryu
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea.
authors.forename: Tae Beom
authors.initials: TB
authors.lastname: Lee
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea.
authors.forename: Young Mok
authors.initials: YM
authors.lastname: Park
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea.
authors.forename: Kwang Ho
authors.initials: KH
authors.lastname: Yang
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea.
authors.forename: Chong Woo
authors.initials: CW
authors.lastname: Chu
authors.affiliation: Department of Pathology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea.
authors.forename: Jung Hee
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea.
authors.forename: Taeun
authors.initials: T
authors.lastname: Kim
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea.|Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea.
authors.forename: Byung Hyun
authors.initials: BH
authors.lastname: Choi
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods*; D004322:Drainage / Q000009:adverse effects / Q000379:methods; D004385:Duodenostomy / Q000009:adverse effects / Q000379:methods*; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016035:Pancreas Transplantation / Q000009:adverse effects / Q000379:methods*; D011182:Postoperative Care / Q000379:methods*
chemical_list: D007166:Immunosuppressive Agents