Living Donor Pancreas Transplantation

In contrast to whole-organ transplants from deceased donors (DDs), only about 50% of the pancreas is procured from living donors (LDs) to achieve insulin independence. The technical aspects of LD pancreas transplants are both similar and different from DD transplants. Like DD transplants, LD grafts are also implanted intraabdominally and preferably on the right side. Pancreatic exocrine secretions are either enteric or bladder drained and systemic venous drainage is preferred over portal venous drainage. The LD segmental transplant can be placed in a caudad or cephalad position and the creation of a Roux-en-Y loop for enteric drainage is recommended. Unlike DD transplants, LD grafts are anastomosed to the external (rather than the common) iliac vessels with the recipient iliac artery in a lateral (rather than medial) position to best align with the donor splenic vessels. Because of the shortness and small diameter of the donor vessels, the vascular anastomoses demand meticulous technical skills as do the pancreatico/ducto-enterostomy or pancreatico/ducto-cystostomy. Aggressive systemic anticoagulation during and after the transplant procedure is key to lasting success.