The unrecognized posterior gastric artery: A potential cause of surgical complications in pancreas transplantation

Background: Our report describes, for the first time, a pretransplant vascular complication in a pancreas graft related to the posterior gastric artery - a major, but relatively unknown side branch of the splenic artery. The posterior gastric artery that was overlooked by a surgical procurement team during donor pancreatectomy led to distortion of the peripancreatic vascular anatomy and set the stage for a splenic artery injury. Methods: We identified the transected, partially resected graft splenic artery during backtable preparation of the pancreas, and repaired it using standard vascular surgical techniques. Results: The recipient's post-operative course was uncomplicated. At 9-yr post-transplant, the recipient is alive with good pancreas graft function. Conclusions: The relevance of the posterior gastric artery with regard to general surgical procedures was only recently recognized. Our case demonstrates that the posterior gastric artery is also important in transplant surgery. Awareness of this anatomical structure during organ procurement would help minimize pre-transplant vascular complications.