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Vessel rejection secondary to human leucocyte antigen antibodies directed against the arterial conduit following pancreas transplantation from a separate donor

Whole‐organ pancreas transplantation is typically carried out using a Y‐graft derived from the donor iliac vessels. We describe a case in which a 31‐year‐old male underwent a simultaneous pancreas‐kidney transplant, but in which vessels from a different donor were used for the arterial anastomosis of the pancreas graft. Although initially there was good function, 18 months post‐transplant the patient was admitted with diabetic ketoacidosis secondary to pancreas graft failure. Radiological investigations revealed complete occlusion of the vascular Y‐graft, and laboratory investigations demonstrated donor‐specific human leucocyte antigen (HLA) antibodies directed against HLA mismatches of the vessel donor. This case highlights the risks of using allogeneic vascular material for surgical anastomoses.