Combined liver-pancreas procurement. Technical problems and arterial reconstructions [IL PRELIEVO COMBINATO FEGATO-PANCREAS. PROBLEMI TECNICI E RICOSTRUZIONE ARTERIOSA]

The presence of vascular anomalies and the need for repeated surgical manoeuvres during multiorgan procurement is sometimes the cause of discussion between pancreas and liver teams. In this publication we propose a combined liver-pancreas procurement technique with back-table arterial reconstruction with the aim of demonstrating that both organs can be procured avoiding long pancreas manipulation also in the presence of a right hepatic artery (RHA) from superior mesenteric artery (SMA). We adopted this technique in 13 cases out of 230 multiorgan donors. In 11 of these back-table arterial reconstruction consisted of an end-to-end anastomosis between the RHA and the splenic artery stump, whereas in 2 cases we used a turned left gastric artery to restore the blood supply to the liver. All patients who received liver grafts with arterial reconstruction had an uneventful postoperative course without thrombosis or stenosis and normal perfusion in all liver segments. None of patients who received pancreas transplantation had postoperative complications related to donor operation. On the bases of these results we think that combined liver-pancreas procurement is an easy and safe surgical procedure performing in all donors. However, our experience is limited on a small number of patients and more experience is necessary before conclusions