09 December 2022: Original Paper
Modification of Venous Outflow to Avoid Thrombotic Graft Failure in Pancreas Transplantation
Je Ho Ryu1ABE, Jae Ryong Shim1ABC, Tae Beom Lee1BCD, Kwangho Yang1ADE, Taeun Kim2ABF, Seo Rin Kim
3EF, Byunghyun Choi1ABCDEF*
DOI: 10.12659/AOT.937514
Ann Transplant 2022; 27:e937514
Figures
Figure 1. The modification of venous outflow. (A) The fence-angioplasty. To enlarge the anastomotic opening, the cadaveric vena cava was divided longitudinally and anastomosed to the graft portal vein horizontally. (B) The aortic interposition graft. The cadaveric aorta was anastomosed end-to-end to the portal vein of pancreatic graft.
Figure 2. End-to-side anastomosis of the fence-angioplasty (A) and the aortic interposition graft (B) to the recipient’s vena cava.
Figure 3. Intraoperative ultrasound findings. Anastomosis site structure, color Doppler and spectral wave of flow were evaluated in both groups (A, the vena cava group; B, the aorta group).
Figure 4. Metabolic findings in both groups. Empty boxes represent the IVC group; hatched boxes represent the aorta group. After transplantation, C-peptide levels were increased and fasting glucose levels were rapidly normalized in each group. The postoperative 1-month C-peptide level was significantly higher in the aorta group owing to the inclusion of PTA recipients with chronic kidney disease, including dialysis, who had impaired endogenous insulin metabolism. Hemoglobin A1c levels were all normalized (<6.5%) after transplant in both groups of recipients.
Figure 5. Graft survival. There was no difference in graft survival between the 2 groups (P=0.815). Graft survival at 1 year was 96.8% in the vena cava group and 92.6% in the aorta group.
Figure 6. The aortic interposition graft schematic. Aortic interposition graft and duodenal exocrine drainage have been used to create a modified venous outlet. In the case of SPK or PAK, the transplanted kidney was implanted on the patient’s left side (left picture). The PTA case is shown on the right. Rune Horneland, a Norwegian transplant surgeon, created this illustration for this article. A – aorta; C – vena cava; D – duodenum, AG – aortic graft; Y – Y-graft. 
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