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Fig. 7.5. Pancreaticoduodenal allograft with exocrine bladder-drainage and systemic venous drainage.

revascularization using a long Y-graft placed through a window in the mesentery to reach the right common iliac artery. Portal venous drainage of the pancreas is more physiologic with respect to immediate delivery of insulin to the recipient liver. This results in diminished circulating insulin levels relative to that in systemic venous-drained pancreas grafts. There has not been documented any clinically relevant difference in glycemic control.

Handling the exocrine drainage of the pancreas is the most challenging aspect of the transplant procedure. There are several methods. Pancreatic exocrine drainage is handled via anastomosis of the duodenal segment to the bladder or anastomosis to the small intestine. The bladder-drained pancreas transplant was a very important modification introduced about 1985. This technique significantly improved the safety of the procedure by minimizing the occurrence of intra-ab-dominal abscess from leakage of enteric-drained pancreas grafts. With the successful application of the new immunosuppressant agents, and the reduction of the incidences of rejection, enteric drainage of the pancreas transplants has enjoyed a successful rebirth.

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Fig. 7.6. Pancreaticoduodenal allograft with exocrine enteric-drainage and venous systemic drainage.

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