Influence of pancreatic duct anastomosis on function of autotransplanted canine pancreatic segments

Autotransplantation of a segment of the right lobe of the canine pancreas affords a model for study of technical operative factors uncomplicated by allograft rejection. Variations of vascular anatomy of the canine pancreas must be recognized before totally vascularized autotransplants can be transferred in the species. Despite the presumed hazard of direct anastomosis in pancreatic transplantation, survival was prolonged, and the incidence of complications was significantly reduced in a group of 12 animals undergoing duct anastomosis in contrast with a high incidence of complications and early deaths in animals in which the duct was simply ligated. The major cause of complications after duct ligation was early thrombosis of the transplant vessel anastomosis, caused presumably by a combination of diminished flow of blood and hypercoagulability of blood secondary to an accentuated inflammatory response within the transplanted segments. No leakage at the anastomosis was observed in the duct-anastomosis group. After duct ligation, four late-surviving animals demonstrated evidence of diabetes after removal of the isotopic right lobe of the pancreas. Four animals surviving after duct anastomosis and right pancreatectomy demonstrate no evidence of diabetes. Histologic studies suggest that fibrosis of the transplant results in islet cell ischemia and malfunction after duct ligation. No significant attenuation of immediate post-transplant pancreatitis could be obtained by intra-arterial irrigation with the antikallikrein, antitryptic agent, Trasylol, before and during the anoxic transfer period.