Impact of Gastroduodenal Artery Reconstruction in Prevention of Duodenal Leaks after Simultaneous Pancreas-Kidney Transplantation
American Journal of Transplantation
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Introduction: Duodenal leak after simultaneous pancreas-kidney (SPK) transplantation with enteric drainage can lead to morbidity and early graft loss. Although the gastroduodenal artery (GDA) provides perfusion to the duodenum, it is typically ligated. This study aims to assess whether reconstruction of the GDA provides reduction in post-operative duodenal leaks after SPK transplantation. Methods: SPK recipients with and without GDA reconstruction were retrospectively identified from the London Health Sciences Center’s transplant database. Recipients were compared with respect to intraoperative donor duodenal micro-capillary perfusion and post-operative biochemical and clinical markers. Results: Between October 2007 and August 2017, 7 SPK recipients had donor GDA reconstruction performed. Compared to 21 recipients of allografts of similar quality as measured by the pancreas donor risk index (p=0.76) but without GDA reconstruction, there was no significant difference in clinical or biochemical parameters. Tissue oxygen saturation of the duodenal bulbs trended towards improved saturation in the reconstruction group but this was not statistically significant. Peak serum lipase (p=0.69), peak serum amylase (p=0.95), and peak drain amylase (p=0.55) levels were similar between reconstruction and non-reconstruction groups. Length of hospital stay (p=0.53), rate of duodenal leaks (p=0.76) and post-operative laparotomy for management of enteric leaks (p=0.21) were not affected by the reconstruction status. Conclusion: Reconstruction of the GDA in SPK transplantation does not appear have added benefit as measured by clinical and biochemical parameters, but larger studies are required to further evaluate these findings, with a particular focus on tissue perfusion.