Technical Aspects of Pancreas Transplantation with Portal Venous Drainage

As of December 2010, more than 35,000 pancreas transplants were reported to the International Pancreas Transplant Registry and nearly 9,000 to the Collaborative Transplant Study databases [1,2]. Pancreas transplantation in diabetic patients is divided into 3 major categories; those performed simultaneously with a kidney (SPK) transplant, usually from a deceased donor; those performed after a successful kidney (PAK) transplant in which the kidney came from either a living or deceased donor; and pancreas transplantation alone (PTA) in the complete absence of a kidney transplant. The latter 2 (PAK and PTA) categories are usually combined together as solitary pancreas transplants. The total number of pancreas transplants steadily increased until 2004 but has since declined, particularly in the PAK category [1,3]. In the last decade, era analyses have demonstrated that deceased donor recovery rates and additions to the waiting list have decreased; discard rates and waiting times have increased; and the proportion of recipients who are older, black, have a higher body mass index, or are characterized as having type 2 diabetes have all increased [1,3]. The majority (75%) of pancreas transplants are performed as SPK transplants whereas approximately 16% are performed as PAK and 9% as PTA transplants, respectively [1,3].