Safe Inclusion of the Entire Pancreas as a Component of the Multivisceral Graft

Multivisceral transplantation (MVtx) involves simultaneous transplantation of the intestine with other organs, often including the pancreas. The pancreas portion of the graft has always been approached with caution because allograft pancreatitis, rejection or technical complications may be devastating in this setting. We reviewed our experience with multivisceral grafts that included the entire pancreas. Twenty-five patients received 27 MVtx that included the entire pancreas between July 2003 and November 2006. In five, a modified MVtx with preservation of the native liver was performed. Two patients required retransplantation for severe rejection. Insulin requirements, graft and patient survival were determined at 6-months posttransplant. Serum amylase and lipase levels were analyzed on postoperative days 3, 7, 30, and 180. Twenty of 25 patients with a transplant pancreas graft were alive at 6-months posttransplant. Median serum amylase and lipase levels posttransplant were normal at all time points. One patient exhibited elevation of amylase and lipase at the time of severe acute cellular rejection of the intestinal graft, likely representing simultaneous pancreas allograft rejection, although this was not confirmed by biopsy. There were no episodes of allograft pancreatitis or technical complications. Once weaned from hyperalimentation, all patients remained normoglycemic and insulin-independent 6-months posttransplant. In this series, there were no postoperative pancreatic complications, no episode of isolated pancreas allograft rejection, and no loss of pancreatic graft function. None of the five deaths were related to pancreatic graft complications.