Discussion
thrombosis, CIA, pancreatitis
THROMBOSIS, COLD, PANCREAS, PANCREATITIS
Pancreas transplantation is mostly done simultaneously with a kidney transplantation (SPK). In this study we have introduced a new arterial anastomosis technique, in which an extension is prepared using the carotid artery. The extension is then anastomosed between the conventional y-graft and the right iliac artery. Preferably, pancreas is transplanted prior to the kidney to reduce the duration of cold ischemic time and reduce the risk of consequent graft failure [In the Y-graft technique, intestinal wall edema may occur due to SMV clamping and there is possibility of difficulty closing the abdominal wall. Furthermore; sometimes the Y-graft reaches the CIA difficultly, creating some tension. To avoid this tension, the splenic arm and superior mesenteric artery (SMA) are cut longer, which could contribute to kinking of the arteries and increased risk of thrombosis. In the common Y-graft technique, it is not possible to estimate the length of the Y-graft until the recipient’s anatomy has been explored, which sometimes inevitably lengthens the cold ischemic time. Therefore, in the Y-graft and extension technique we prepare the graft with an extra arterial extension to decrease the cold ischemic duration and as stated, the duration of operation tends to be shorter. For venous outflow, we used to prepare the graft for the portal drainage technique rather than the systemic one, this would result in a long Y-graft which might be kinked, increasing the risk of thrombosis [Another difficulty of the Y-graft and extension technique is the need for an extra conduit. As a significant length of the donor’s iliac artery is preserved for the liver, the problem is solved by taking the required vascular conduit from donor’s carotid artery.Our results showed the incidence of pancreatitis and rejection was lower in the new Y-graft and extension procedure compared to traditional Y-graft technique. We assume that the mentioned results occurred due to less graft manipulation. As previous studies have reported a low tolerance of pancreas graft to the manipulation [