Bench reconstruction of pancreas for transplantation: experience with 192 cases

Whole organ pancreaticoduodenal transplantation with bladder drainage by the duodenal segment technique is currently the preferred method of vascularized pancreas transplantation but is associated with a finite risk of surgical complications. Meticulous bench reconstruction of the pancreaticoduodenal allograft may minimize complications following transplantation. Over a 6.5‐yr period, 192 pancreas transplants were performed in 181 diabetic patients by the same transplant team. A retrospective review was performed in order to describe a stepwise approach to bench preparation of the pancreaticoduodenal allograft that has developed from this experience. In this series of 192 consecutive pancreaticoduodenal reconstructions, no procured pancreas was deemed non‐usable solely from an anatomic standpoint. The mean backtable pancreas preparation time was 2 h. The operative complication rate was 19%, the incidence of technical graft loss was 6.8%, and there was no mortality related to technical problems. Conclusions: Using a standardized approach, meticulous bench reconstruction of the pancreaticoduodenal allograft: 1) can be performed in virtually any anatomic setting; 2) decreases complications following transplantation; 3) improves initial allograft function; and 4) minimizes organ wastage.