Surgical techniques for deceased donor pancreas transplantation

The technical aspects of pancreas transplantation are both challenging and complex. From the first clinical pancreas transplant in 1966 by Kelly and Lillehei at the University of Minnesota over the first segmental living donor pancreas transplant in 1979 to robotically performed pancreas transplants in the current era, pancreas transplantation has evolved with many technical modifications over the past 50 years at a steep pace. While 1-year mortality rates in the first two decades were as high as 30% and 1-year graft failure rates as high as 80%, current 1-year mortality rates are < 5% and graft failure rates < 20% at 1 year. These tremendous improvements have been achieved due to the introduction of potent immunosuppressive drugs, in particular calcineurin inhibitors, and potent antimicrobial drugs, in particular acyclovir/gancyclovir and antifungal agents. But above all, improvements in surgical techniques, intraoperative management, and close posttransplant monitoring have contributed to excellent short- and long-term outcome. A whole-organ, deceased donor pancreas transplant with enteric and systemic venous drainage has become the gold standard of surgical techniques. Despite many advances in insulin therapy, a pancreas transplant remains the best treatment option for insulin-dependent patients to achieve the goal of insulin independence.