Abstract
Pancreas transplantation and simultaneous pancreas-kidney transplantation(SPK) have been recognized as the best treatment for type 1 diabetic patients. The number of brain-death donors has been increasing in Japan since the revision of the Organ Transplantation Act on July 2010. For the transplant surgeons, appropriate operative techniques for multi-organ procurement from both brain-dead and non-heart-beating donors (from bench surgery including the inspection of the graft and vascular reconstruction) and recipient surgery are necessary in order to achieve successful outcomes.
Procurement of the pancreas from a brain-dead donor is different depending whether removal of the intestine and/or the liver is performed. We usually prioritize the small intestine and first cut the superior mesenteric vessels, proceeding next to the liver to give way to the hepatic artery, the splenic artery and the portal vein. In any case, we use the "Super Rapid Technique" combined with core cooling and surface cooling to reduce excess manipulation and to avoid organ warming during the procurement process. For the recipient operation, we usually position the pancreas graft on the right iliac fossa to anastmose the graft vessels onto the external iliac vessels and to drain pancreatic juice either to the intestine or bladder. In the case of SPK, the kidney graft is usually placed on the opposite side, left iliac fossa extraperitoneally.
Herein, the current standard and most favorable techniques for pancreas transplantation in Japan have been described.
