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Review
. 2020 Dec 28;10(12):381-391.
doi: 10.5500/wjt.v10.i12.381.

Complications during multiorgan retrieval and pancreas preservation

Daniel Casanova  1 , Gonzalo Gutierrez  2 , Monica Gonzalez Noriega  2 , Federico Castillo  2
Affiliations
Review

Complications during multiorgan retrieval and pancreas preservation

Daniel Casanova et al. World J Transplant. .

Abstract

In pancreas transplantation, complications can arise at each step of the process, from the initial selection of donors and recipients through the surgical technique itself and the post-operative period, when lifelong immunosuppression is required. In the early steps, careful retrieval and preservation of the pancreas are crucial for the viability of the organ and ultimate success of the transplant. The pancreas is a low-flow gland, making it highly sensitive to transplantation conditions and presenting risk of pancreatitis due to periods of ischemia. The two groups of donors - after brain death (DBD) or after cardiac arrest (DCD) - require different strategies of retrieval and preservation to avoid or reduce the risk of complications developing during and after the transplantation. For DBD donor transplantation, multiorgan retrieval and cold preservation is the conventional technique. Asystole donor (DCD) transplantation, in contrast, can benefit from the newest technologies, such as hypothermic and especially normothermic preservation machines (referred to as NECMO), to optimize organ preservation. The latter has led to an increase in the pool of donors by facilitating recuperation of organs for transplantation that would have been discarded otherwise.

Keywords: Compartmental syndrome; Diabetes mellitus; Graft thrombosis; Pancreas preservation; Pancreas retrieval; Pancreas transplantation.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Right hepatic artery from mesenteric superior artery.
Figure 2
Figure 2
Right hepatic artery from mesenteric superior artery. A: Intraoperative view; B: Overlayed with identifiers. SMA: Superior mesenteric artery; IPDA: Inferior pancreaticoduodenal artery; rRHA: Replaced right hepatic artery.
Figure 3
Figure 3
Arterial vasculature of the pancreas. Illustrated from the view of contemporary surgery. A: Anterior; B: Posterior.
Figure 4
Figure 4
Pancreas graft mobilization. A: Photo; B: Drawing from Martin Finch.
Figure 5
Figure 5
Retrieval of pancreas and liver. A and B: Intraoperative views of the retrieval procedure, showing different aspects.
Figure 6
Figure 6
Pancreatico-duodenal graft. A and B: Intraoperative views of the bench preparation procedure, showing different aspects.
Figure 7
Figure 7
Venous vessels. Illustrated from the view of contemporary surgery. A: Anterior view; B: Posterior view.
Figure 8
Figure 8
Portal vein.
Figure 9
Figure 9
Aortic canula in super-fast retrieval. A and B: Intraoperative views of the procedure, showing different aspects. Photos provided by Dr Perez Daga, pancreas transplant surgeon (Malaga, Spain).
Figure 10
Figure 10
Normothermic circulation. A: Picture of normothermic preservation machines (NECMO); B: Diagram of NECMO. NECMO: Normothermic preservation machines.
Figure 11
Figure 11
Negative-pressure wound therapy.
See this image and copyright information in PMC

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