Surgical techniques for living donor pancreas transplantation

The pancreas was the first extrarenal organ that was successfully transplanted from a living donor in 1979. The objective of the procedure is to cure diabetes mellitus and to achieve insulin independence and normoglycemia. In the pre-calcineurin inhibitor era, LD pancreas transplantation offered improved graft survival compared to deceased donor transplants. In the calcineurin inhibitor era, this difference is hardly existent anymore and pancreas transplants from living donors are only performed in the presence of at least 1-haplotype human leukocyte antigen (HLA)-matches, high antibody [panel reactive antibody (PRA)] levels and need for low-dose immunosuppression. With improvements in surgical techniques, anticoagulation and immunosuppression, a living donor pancreas transplant remains a treatment option in selected patients due to elimination of waiting time, decreased rejection rates, and low-dose immunosuppression. Removal and transplantation of a living donor hemi-pancreas using the pancreatic tail with the splenic vessels can be accomplished with a very low surgical risk to both donor and recipient.