Reconstruction of gastroduodenal artery in combined pancreas-kidney transplantation

Objective To study the procedure of gastroduodenal artery (GDA) reconstruction in combined pancreas-kidney transplantation (CPKT) and to evaluate the impact of this technique on the surgical complications of the pancreas allograft.Method Between January 2000 and August 2013,68 diabetic patients underwent pancreas transplantation:65 transplantations of simultaneous pancreaskidney and 3 transplantations of pancreas after kidney transplantation.Among 68 whole pancreas grafts,8 came from pancreas-kidney harvesting without necessitating GDA reconstruction.In the rest 60 cases,the distal common hepatic artery and the proximal GDA were divided to liver graft,leaving the aortic patch carrying the celiac trunk and superior mesenteric artery for the pancreas.The GDA reconstruction was routinely employed except one.The GDA was mostly anastomosed end-to-end with the common hepatic artery or left gastric artery,with or without interposing a donor mesentery artery.Result The GDA was successfully reconstructed in 57 cases.GDA reconstruction was abandoned in 2 cases duce to thrombosis and high tension between GDA and common hepatic artery.The GDA supply was restored in 65 of 68 pancreas allografts.Fifteen patients (22.1％) underwent one or more relaparotomies.The causes for relaparotomy were:graft thrombosis in 2 cases (2.9％),bleeding in 6 cases (8.8％),severe pancreatitis in one case (1.5％),and infection in 7 cases (10.3％).Graft pancreatectomy was performed in 33.3％ (5 patients).The causes of graft loss were:graft thrombosis in 2 cases (2.9％),bleeding in 2 cases (2.9％),and severe pancreatitis in one case (1.5％).Mortality rate after relaparotomy was 4.4％ (three patients).Conclusion The reconstruction of GDA may ensure a better blood supply to the pancreas and duodenum and furthermore decrease the surgical complication and technical failure in CPKT. Key words: Pancreas transplantation;  Gastroduodenal artery;  Vessel reconstruction;  Surgical complication