immunology allergic disorders
Pancreas Transplantation
Procedure
The donor is anticoagulated, and a cold preservation solution is flushed into the celiac artery. The pancreas is cooled in situ with iced saline slush, then removed en bloc with the liver (for transplantation into a different recipient) and the 2nd portion of the duodenum containing the ampulla of Vater. The iliac artery is also removed. The donor pancreas is positioned intraperitoneally and laterally in the lower abdomen of the recipient. In simultaneous pancreas-kidney transplantation, the pancreas is placed into the right middle area of the recipient’s abdomen and the kidney into the left lower quadrant. The native pancreas is left in place. The donor iliac artery is used for reconstruction on the back table to reconstruct the splenic artery and superior mesenteric artery of the pancreas graft. This technique results in one artery for connection to the recipient blood vessels. The final anastomoses are made between the donor iliac artery and one of the recipient's iliac arteries and between the donor portal vein and recipient iliac vein. Thus, endocrine secretions drain systemically, causing hyperinsulinemia; sometimes the donor pancreatic venous system is anastomosed to a portal vein tributary to re-create physiologic conditions, although this procedure is more demanding and its benefits are unclear. The duodenum is sewn to the bladder dome or to the jejunum for drainage of exocrine secretions. vary but typically include immunosuppressive immunoglobulins, a calcineurin inhibitor, a purine synthesis inhibitor, and corticosteroids (which can be slowly tapered over 12 months). (See also Posttransplantation Immunosuppression ). 