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World J Transplant. Dec 28, 2020; 10(12): 381-391
Published online Dec 28, 2020. doi: 10.5500/wjt.v10.i12.381
Complications during multiorgan retrieval and pancreas preservation
Daniel Casanova, Gonzalo Gutierrez, Monica Gonzalez Noriega, Federico Castillo
Daniel Casanova, Department of Surgery, University Hospital Marques de Valdecilla, University Cantabria, Santander 39008, Cantabria, Spain
Gonzalo Gutierrez, Monica Gonzalez Noriega, Federico Castillo, Department of Surgery, University Hospital Marques de Valdecilla, Santander 39008, Cantabria, Spain
Author contributions: Casanova D designed the review and serves as guarantor; Gutierrez G, Gonzalez Noriega M and Castillo F contributed important intellectual content to the document.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Daniel Casanova, FACS, FRCS (Ed), MD, PhD, Full Professor, Surgeon, Department of Surgery, University Hospital Marques de Valdecilla, University Cantabria, Chairman Board Europeo de Trasplante, Servicio de Cirugía General y Digestiva Hospital Universitario Marqués de Valdecilla, Santander 39008, Cantabria, Spain. daniel.casanova@unican.es
Received: June 20, 2020
Peer-review started: June 18, 2020
First decision: July 25, 2020
Revised: August 4, 2020
Accepted: October 5, 2020
Article in press: October 5, 2020
Published online: December 28, 2020
Processing time: 186 Days and 11.5 Hours
Abstract

In pancreas transplantation, complications can arise at each step of the process, from the initial selection of donors and recipients through the surgical technique itself and the post-operative period, when lifelong immunosuppression is required. In the early steps, careful retrieval and preservation of the pancreas are crucial for the viability of the organ and ultimate success of the transplant. The pancreas is a low-flow gland, making it highly sensitive to transplantation conditions and presenting risk of pancreatitis due to periods of ischemia. The two groups of donors - after brain death (DBD) or after cardiac arrest (DCD) - require different strategies of retrieval and preservation to avoid or reduce the risk of complications developing during and after the transplantation. For DBD donor transplantation, multiorgan retrieval and cold preservation is the conventional technique. Asystole donor (DCD) transplantation, in contrast, can benefit from the newest technologies, such as hypothermic and especially normothermic preservation machines (referred to as NECMO), to optimize organ preservation. The latter has led to an increase in the pool of donors by facilitating recuperation of organs for transplantation that would have been discarded otherwise.

Keywords: Pancreas transplantation; Diabetes mellitus; Graft thrombosis; Compartmental syndrome; Pancreas retrieval; Pancreas preservation

Core Tip: The retrieval and preservation steps of pancreas transplantation are critical factors for graft and patient survival. The most frequent complications of these steps are pancreatitis, graft thrombosis, fistula, and infectious collections. Therefore, it is very important to design and carry out a careful surgical technique for retrieval and a rigorous method of preservation for optimal organ integrity.