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  • Print publication year: 2011
  • Online publication date: September 2011

Chapter 34 - Pancreatic transplantation

from Section 6 - Other abdominal organs

Summary

A successful liver transplant requires a number of procedures, including donor hepatectomy, preparation of the donor liver, recipient hepatectomy, and implantation of the liver graft. A midline laparotomy and sternotomy are performed and can be extended using transverse abdominal incisions to maximize surgical access. Preparation of the liver for transplantation is usually performed following a period of efficient cooling in an ice box and transportation to the recipient center. The hepatectomy begins with division of the left triangular ligament, falciform ligament, and lesser omentum before moving to the hilum. The greatest challenge when performing the portal venous anastomosis is the presence of portal vein thrombosis (PVT), which was originally an absolute contraindication to liver transplantation, but is now part of standard practice. Reperfusion of the liver is often the most dangerous part of the transplant procedure, and close communication between surgeon and anesthetist is crucial.

Further reading

American Diabetes Association. Economic Costs of Diabetes in the U.S. in 2002. Diabetes Care 2003; 26: 917.
AxelrodD, SungR, MeyerKH, WolfeRA, KaufmanDB. Systematic evaluation of pancreas allograft quality, outcomes, and geographic variation in utilization. Am J Transplant 2010; 10: 837.
OjoAO, Meier-KriescheHU, HansonJA, et al. Impact of simultaneous pancreas-kidney transplantation on long-term patient survival. Transplantation 2001; 71: 82.
OPTN/UNOS Pancreas Transplantation Committee Report to the Board of Directors, Juen 21–22, 2010, Richmond, VA. Available at: http://optn.transplant.hrsa.gov/CommitteeReports/board_main_PancreasTransplantationCommittee_6_24_2010_9_59.pdf
SalvalaggioPR, DaviesDB, FernandezLA, KaufmanDB. Outcomes of pancreas transplantation in the United States using cardiac-death donors. Am J Transplant 2006; 6: 1059.