Pancreas Transplantation Alone from Very Small Pediatric Donor Using a Novel Cephalic Placement Tecnique

Pediatric donors are rarely used in pancreas transplantation for the higher technical challenge and the poor outcome due to the inadequate islet number. However, the shortage of pancreatic donors made mandatory to extend criteria for donor eligibility. Several reports have addressed the feasibility of pancreas transplantation from pediatric donor and have shown comparable outcomes to adult donors in terms of long-term beta cell function. However there is no consensus yet about donor age limit. We present the case of PTA (Pancreas Transplantation Alone) from a 24 months old pediatric donor. We used a novel “cephalic placement” technique. The systemic venous anastomosis was performed between donor portal vein and recipient left common iliac vein, whereas arterial anastomosis was performed with the right common iliac artery of the recipient. Pancreas was placed upon the iliac carrefour with cephalic pole upward. Pancreatic exocrine drainage was realized via anastomosis of the duodenal segment to the small intestine proximal to the Treitz ligament in order to give the graft more fixity. No postoperative thrombosis occurred in a short term follow up and the patient gained insulin independence instantaneously. CT scan performed on post operative day 3 showed regular arterial and venous organ perfusion with normal parenchymal contrastographic pattern and vascular density. Graft volume calculated by CT reconstruction was 25 cc and surface was 89 cm2. Patient remained insulin-independent at 7 months follow-up. Post operative mixed meal tolerance test showed normal glycemic profile. Herein, for the first time, we report the feasibility and efficacy of PTA from very small pediatric donor using a novel surgical technique that gives the graft relative fixity, thus avoiding vessels kinking and reducing thrombosis rate.