Pancreas Transplant with Duodeno-Duodenostomy and Caval Drainage Using a Diamond Patch Graft: A Single-Center Experience

Ryu, Je Ho; Lee, Tae Beom; Park, Young Mok; Yang, Kwangho; Chu, Chong Woo; Lee, Jun Young; Kim, Tae-Un; Choi, Byung Hyun

doi:10.12659/aot.901469

Cited by 13 publications

(16 citation statements)

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“…We followed some different approaches to venous anastomosis. The diamond-shaped patch (D-patch) is the one of them [ 12 ]. Unfortunately, the D-patch technique could not guarantee the wide opening in the postoperative CT scan ( Table 2 ).…”

Section: Discussionmentioning

confidence: 99%

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Fence Angioplasty Prevents Narrowing of Venous Anastomosis in Solitary Pancreas Transplant

et al. 2018

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BackgroundGraft thrombosis is the leading cause of early graft failure in pancreas transplants. Direct anastomosis grafting of the portal vein to the iliac vein or vena cava generally appears narrowed on postoperative computed tomography (CT) scans. However, modification of surgical techniques may prevent venous narrowing, which also prevents thrombosis-related graft failure.Material/MethodsWe performed 31 solitary pancreas transplants since 2015. Retrospective analysis of these patients was performed.ResultsFence angioplasty was applied in the final 12 cases, and no technical failures or early graft losses occurred in these cases. Three graft losses, including 2 immunologic losses and 1 patient death with functioning graft, occurred after at least postoperative 4 months. The venous anastomoses were evaluated via intraoperative Doppler ultrasound and postoperative CT scans. Intraoperative Doppler ultrasound revealed improved spectral waves of venous anastomoses in the fence group (monophasic spectral wave, 42.9% vs. 0%, p=0.017). The fence-graft applied group had no cases of narrowing, whereas the non-fence group had high narrowing rates on CT scans (84.2% vs. 0%, p<0.001). Furthermore, with less use of postoperative heparin, postoperative bleeding rates were lower in the fence group (36% vs. 0%, p=0.026).ConclusionsFence angioplasty is a definitive method for avoiding venous anastomotic stenosis and preventing graft failure due to thrombosis.

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Section: Discussionmentioning

confidence: 99%

“…After drain tube insertion, the wound was closed. This procedure was described in our previous report [ 12 ].…”

Section: Methodsmentioning

confidence: 99%

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Fence Angioplasty Prevents Narrowing of Venous Anastomosis in Solitary Pancreas Transplant

et al. 2018

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“…Patient-and graft-survival following SPK and PTA have improved during the last decades, but rejections continue to be a clinical challenge. 3,8 However, data presented at the Banff 2015 pancreas session suggested that a normal duodenal cuff biopsy could predict absence of T cell-mediated rejection in the pancreas parenchyma. 2 Hyperglycemia is a symptom of rejection that often occurs at a time when irreversible organ damage is already established.…”

Section: Introductionmentioning

confidence: 99%

“…7 Some publications suggest that surveillance biopsies of donor duodenal mucosa may be used as a less invasive alternative for pancreas recipients, but this has never been fully explored. 3,8 However, data presented at the Banff 2015 pancreas session suggested that a normal duodenal cuff biopsy could predict absence of T cell-mediated rejection in the pancreas parenchyma. 9 The surgical technique with duodeno-duodenal enteroanastomosis of pancreas transplants allows for representative endoscopic ultrasound-guided needle biopsies of the donor duodenum and the pancreas graft.…”

Section: Introductionmentioning

confidence: 99%

Pancreas transplant rejection episodes are not revealed by biopsies of the donor duodenum in a prospective study with paired biopsies

Nordheim

Horneland

Aandahl

et al. 2018

American Journal of Transplantation

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The surgical technique with duodeno-duodenal enteroanastomosis of pancreas transplants allows for representative endoscopic ultrasound-guided needle biopsies of the donor duodenum and the pancreas graft. We assessed whether histological findings in transplanted donor duodenal biopsies can indicate rejection in the transplanted pancreas. Since September 2012, a duodeno-duodenal enteroanastomosis has been the default technique for pancreas transplantations at our center. In 67 recipients we prospectively examined 113 endoscopic ultrasound-guided procedures with representative biopsies from the duodenum grafts and the pancreas grafts (97 per protocol and 16 on indication). All graft biopsies were evaluated according to established rejection criteria. A total of 22 biopsy-proven pancreas rejections were detected, with 2 matching duodenal biopsies showing rejection. This gives a sensitivity of 9% for detection of a pancreas rejection by duodenal biopsies. The other matching duodenal biopsies were either normal (n = 13) or indeterminate (n = 7). Rejection of the donor duodenum was found in only 6/113 biopsies, with 2 concurrent pancreas rejections. In conclusion, the donor duodenum is not a useful reporter organ for rejection in the pancreas graft.

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Duodenal Drainage: The South American Experience (Brazil)

Perosa,

Danziere,

Branez

et al. 2023

Transplantation of the Pancreas

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Pancreas Transplant with Duodeno-Duodenostomy and Caval Drainage Using a Diamond Patch Graft: A Single-Center Experience

Cited by 13 publications

References 0 publications

Fence Angioplasty Prevents Narrowing of Venous Anastomosis in Solitary Pancreas Transplant

Fence Angioplasty Prevents Narrowing of Venous Anastomosis in Solitary Pancreas Transplant

Pancreas transplant rejection episodes are not revealed by biopsies of the donor duodenum in a prospective study with paired biopsies

Duodenal Drainage: The South American Experience (Brazil)

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